Methods for Treating Disseminated Intravascular Coagulation by Inhibiting MASP-2 Dependent Complement Activation

ABSTRACT

In one aspect, the invention provides methods of inhibiting the effects of MASP-2-dependent complement activation in a living subject. In one embodiment, the invention provides methods of treating a subject suffering from a complement mediated coagulation disorder, such as disseminated intravascular coagulation. The methods comprise the step of administering, to a subject in need thereof, an amount of a MASP-2 inhibitory agent effective to inhibit MASP-2-dependent complement activation. In some embodiments, the MASP-2 inhibitory agent inhibits cellular injury associated with MASP-2-mediated alternative complement pathway activation, while leaving the classical (C1q-dependent) pathway component of the immune system intact. In another aspect, the invention provides compositions for inhibiting the effects of lectin-dependent complement activation, comprising a therapeutically effective amount of a MASP-2 inhibitory agent and a pharmaceutically acceptable carrier.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation of pending U.S. application Ser. No.14/168,785, filed Jan. 30, 2014, which is a continuation of U.S.application Ser. No. 12/905,972, filed Oct. 15, 2010, now issued as U.S.Pat. No. 8,652,477, and claims the benefit of Provisional ApplicationNo. 61/279,279, filed Oct. 16, 2009, and Provisional Application No.61/322,722, filed Apr. 9, 2010, all of which are incorporated herein byreference in their entirety.

STATEMENT REGARDING SEQUENCE LISTING

The sequence listing associated with this application is provided intext format in lieu of a paper copy and is hereby incorporated byreference into the specification. The name of the text file containingthe sequence listing isMP_1_0111_US4_SequenceListingasFiled_20161212.txt. The text file is 109KB; was created on Dec. 9, 2016; and is being submitted via EFS-Web withthe filing of the specification.

BACKGROUND

The complement system provides an early acting mechanism to initiate andamplify the inflammatory response to microbial infection and other acuteinsults (M.K. Liszewski and J. P. Atkinson, 1993, in FundamentalImmunology, Third Edition, edited by W. E. Paul, Raven Press, Ltd., NewYork). While complement activation provides a valuable first-linedefense against potential pathogens, the activities of complement thatpromote a protective inflammatory response can also represent apotential threat to the host (K. R. Kalli, et al., Springer Semin.Immunopathol. 15:417-431, 1994; B. P. Morgan, Eur. J. Clinical Investig.24:219-228, 1994). For example, C3 and C5 proteolytic products recruitand activate neutrophils. These activated cells are indiscriminate intheir release of destructive enzymes and may cause organ damage. Inaddition, complement activation may cause the deposition of lyticcomplement components on nearby host cells as well as on microbialtargets, resulting in host cell lysis.

The complement system has been implicated as contributing to thepathogenesis of numerous acute and chronic disease states, including:myocardial infarction, revascularization following stroke, ARDS,reperfusion injury, septic shock, capillary leakage following thermalburns, postcardiopulmonary bypass inflammation, transplant rejection,rheumatoid arthritis, multiple sclerosis, myasthenia gravis, andAlzheimer's disease. In almost all of these conditions, complement isnot the cause but is one of several factors involved in pathogenesis.Nevertheless, complement activation may be a major pathologicalmechanism and represents an effective point for clinical control in manyof these disease states. The growing recognition of the importance ofcomplement-mediated tissue injury in a variety of disease statesunderscores the need for effective complement inhibitory drugs. No drugshave been approved for human use that specifically target and inhibitcomplement activation.

Currently, it is widely accepted that the complement system can beactivated through three distinct pathways: the classical pathway, thelectin pathway, and the alternative pathway. The classical pathway isusually triggered by antibody bound to a foreign particle (i.e., anantigen) and thus requires prior exposure to that antigen for thegeneration of specific antibody. Since activation of the classicalpathway is associated with development of an immune response, theclassical pathway is part of the acquired immune system. In contrast,both the lectin and alternative pathways are independent of clonalimmunity and are part of the innate immune system.

The first step in activation of the classical pathway is the binding ofa specific recognition molecule, C1q, to antigen-bound IgG and IgM. Theactivation of the complement system results in the sequential activationof serine protease zymogens. C1q is associated with the C1r and C1sserine protease proenzymes as a complex called C1 and, upon binding ofC1q to an immune complex, autoproteolytic cleavage of the Arg-Ile siteof C1r is followed by C1r activation of C1s, which thereby acquires theability to cleave C4 and C2. The cleavage of C4 into two fragments,designated C4a and C4b, allows the C4b fragments to form covalent bondswith adjacent hydroxyl or amino groups and the subsequent generation ofC3 convertase (C4b2b) through noncovalent interaction with the C2bfragment of activated C2. C3 convertase (C4b2b) activates C3 leading togeneration of the C5 convertase (C4b2b3b) and formation of the membraneattack complex (C5b-9) that can cause microbial lysis. The activatedforms of C3 and C4 (C3b and C4b) are covalently deposited on the foreigntarget surfaces, which are recognized by complement receptors onmultiple phagocytes.

Independently, the first step in activation of the complement system bythe lectin pathway is also the binding of specific recognitionmolecules, which is followed by the activation of associated serineproteases. However, rather than the binding of immune complexes by C1q,the recognition molecules in the lectin pathway are carbohydrate-bindingproteins (mannan-binding lectin (MBL), H-ficolin, M-ficolin, andL-ficolin) (J. Lu et al., Biochim. Biophys. Acta 1572:387-400, 2002;Holmskov et al., Annu. Rev. Immunol. 21:547-578 (2003); Teh et al.,Immunology 101:225-232 (2000)). Ikeda et al. first demonstrated that,like C1q, MBL could activate the complement system upon binding to yeastmannan-coated erythrocytes in a C4-dependent manner (K. Ikeda et al., J.Biol. Chem. 262:7451-7454, 1987). MBL, a member of the collectin proteinfamily, is a calcium-dependent lectin that binds carbohydrates with 3-and 4-hydroxy groups oriented in the equatorial plane of the pyranosering. Prominent ligands for MBL are thus D-mannose andN-acetyl-D-glucosamine, while carbohydrates not fitting this stericrequirement have undetectable affinity for MBL (Weis, W. I., et al.,Nature 360:127-134, 1992). The interaction between MBL and monovalentsugars is extremely weak, with dissociation constants typically in the 2mM range. MBL achieves tight, specific binding to glycan ligands byinteraction with multiple monosaccharide residues simultaneously (Lee,R. T., et al., Archiv. Biochem. Biophys. 299:129-136, 1992). MBLrecognizes the carbohydrate patterns that commonly decoratemicroorganisms such as bacteria, yeast, parasites and certain viruses.In contrast, MBL does not recognize D-galactose and sialic acid, thepenultimate and ultimate sugars that usually decorate “mature” complexglycoconjugates present on mammalian plasma and cell surfaceglycoproteins. This binding specificity is thought to help protect fromself activation. However, MBL does bind with high affinity to clustersof high-mannose “precursor” glycans on N-linked glycoproteins andglycolipids sequestered in the endoplasmic reticulum and Golgi ofmammalian cells (Maynard, Y., et al., J. Biol. Chem. 257:3788-3794,1982). Therefore, damaged cells are potential targets for lectin pathwayactivation via MBL binding. The ficolins possess a different type oflectin domain than MBL, called the fibrinogen-like domain. Ficolins bindsugar residues in a Ca⁺⁺-independent manner. In humans, three kinds officolins, L-ficolin, M-ficolin and H-ficolin, have been identified. Bothserum ficolins L-ficolin and H-ficolin have in common a specificity forN-acetyl-D-glucosamine; however, H-ficolin also bindsN-acetyl-D-galactosamine. The difference in sugar specificity ofL-ficolin, H-ficolin and MBL means that the different lectins may becomplementary and target different, though overlapping, glycoconjugates.This concept is supported by the recent report that, of the knownlectins in the lectin pathway, only L-ficolin binds specifically tolipoteichoic acid, a cell wall glycoconjugate found on all Gram-positivebacteria (Lynch, N. J., et al., J. Immunol. 172:1198-1202, 2004). Thecollectins (i.e., MBL) and the ficolins bear no significant similarityin amino acid sequence. However, the two groups of proteins have similardomain organizations and, like C1q, assemble into oligomeric structures,which maximize the possibility of multisite binding. The serumconcentrations of MBL are highly variable in healthy populations andthis is genetically controlled by the polymorphism/mutations in both thepromoter and coding regions of the MBL gene. As an acute phase protein,the expression of MBL is further upregulated during inflammation.L-ficolin is present in serum at similar concentrations as MBL.Therefore, the L-ficolin arm of the lectin pathway is potentiallycomparable to the MBL arm in strength. MBL and ficolins can alsofunction as opsonins, which require interaction of these proteins withphagocyte receptors (Kuhlman, M., et al., J. Exp. Med. 169:1733, 1989;Matsushita, M., et al., J. Biol. Chem. 271:2448-54, 1996). However, theidentities of the receptor(s) on phagocytic cells have not beenestablished.

Human MBL forms a specific and high affinity interaction through itscollagen-like domain with unique C1r/C1s-like serine proteases, termedMBL-associated serine proteases (MASPs). To date, three MASPs have beendescribed. First, a single enzyme “MASP” was identified andcharacterized as the enzyme responsible for the initiation of thecomplement cascade (i.e., cleaving C2 and C4) (Ji, Y. H., et al., J.Immunol. 150:571-578, 1993). Later, it turned out that MASP is in fact amixture of two proteases: MASP-1 and MASP-2 (Thiel, S., et al., Nature386:506-510, 1997). However, it was demonstrated that the MBL-MASP-2complex alone is sufficient for complement activation (Vorup-Jensen, T.,et al., J. Immunol. 165:2093-2100, 2000). Furthermore, only MASP-2cleaved C2 and C4 at high rates (Ambrus, G., et al., J. Immunol.170:1374-1382, 2003). Therefore, MASP-2 is the protease responsible foractivating C4 and C2 to generate the C3 convertase, C4b2b. This is asignificant difference from the C1 complex, where the coordinated actionof two specific serine proteases (C1r and C1s) leads to the activationof the complement system. Recently, a third novel protease, MASP-3, hasbeen isolated (Dahl, M. R., et al., Immunity 15:127-35, 2001). MASP-1and MASP-3 are alternatively spliced products of the same gene. Thebiological functions of MASP-1 and MASP-3 remain to be resolved.

MASPs share identical domain organizations with those of C1r and Cls,the enzymatic components of the Cl complex (Sim, R. B., et al., Biochem.Soc. Trans. 28:545, 2000). These domains include an N-terminalC1r/C1s/sea urchin Vegf/bone morphogenic protein (CUB) domain, anepidermal growth factor-like domain, a second CUB domain, a tandem ofcomplement control protein domains, and a serine protease domain. As inthe C1 proteases, activation of MASP-2 occurs through cleavage of anArg-Ile bond adjacent to the serine protease domain, which splits theenzyme into disulfide-linked A and B chains, the latter consisting ofthe serine protease domain. Recently, a genetically determineddeficiency of MASP-2 was described (Stengaard-Pedersen, K., et al., NewEng. J. Med. 349:554-560, 2003). The mutation of a single nucleotideleads to an Asp-Gly exchange in the CUB1 domain and renders MASP-2incapable of binding to MBL.

MBL is also associated with a nonenzymatic protein referred to asMBL-associated protein of 19 kDa (MAp19) (Stover, C. M., J. Immunol.162:3481-90, 1999) or small MBL-associated protein (sMAP) (Takahashi,M., et al., Int. Immunol. 11:859-863, 1999). MAp19 is formed byalternative splicing of the MASP 2 gene product and comprises the firsttwo domains of MASP-2, followed by an extra sequence of four uniqueamino acids. The MASP 1 and MASP 2 genes are located on chromosomes 3and 1, respectively (Schwaeble, W., et al., Immunobiology 205:455-466,2002).

Several lines of evidence suggest that there are different MBL-MASPscomplexes and a large fraction of the total MASPs in serum is notcomplexed with MBL (Thiel, S., et al., J. Immunol. 165:878-887, 2000).Both H- and L-ficolin are associated with

MASP and activate the lectin complement pathway, as does MBL (Dahl, M.R., et al., Immunity 15:127-35, 2001; Matsushita, M., et al., J.Immunol. 168:3502-3506, 2002). Both the lectin and classical pathwaysform a common C3 convertase (C4b2b) and the two pathways converge atthis step.

The lectin pathway is widely thought to have a major role in hostdefense against infection. Strong evidence for the involvement of MBL inhost defense comes from analysis of patients with decreased serum levelsof functional MBL (Kilpatrick, D. C., Biochim. Biophys. Acta1572:401-413, 2002). Such patients display susceptibility to recurrentbacterial and fungal infections. These symptoms are usually evidentearly in life, during an apparent window of vulnerability as maternallyderived antibody titer wanes, but before a full repertoire of antibodyresponses develops. This syndrome often results from mutations atseveral sites in the collagenous portion of MBL, which interfere withproper formation of MBL oligomers. However, since MBL can function as anopsonin independent of complement, it is not known to what extent theincreased susceptibility to infection is due to impaired complementactivation.

Although there is extensive evidence implicating both the classical andalternative complement pathways in the pathogenesis of non-infectioushuman diseases, the role of the lectin pathway is just beginning to beevaluated. Recent studies provide evidence that activation of the lectinpathway can be responsible for complement activation and relatedinflammation in ischemia/reperfusion injury. Collard et al. (2000)reported that cultured endothelial cells subjected to oxidative stressbind MBL and show deposition of C3 upon exposure to human serum(Collard, C. D., et al., Am. J. Pathol. 156:1549-1556, 2000). Inaddition, treatment of human sera with blocking anti-MBL monoclonalantibodies inhibited MBL binding and complement activation. Thesefindings were extended to a rat model of myocardial ischemia-reperfusionin which rats treated with a blocking antibody directed against rat MBLshowed significantly less myocardial damage upon occlusion of a coronaryartery than rats treated with a control antibody (Jordan, J. E., et al.,Circulation 104:1413-1418, 2001). The molecular mechanism of MBL bindingto the vascular endothelium after oxidative stress is unclear; a recentstudy suggests that activation of the lectin pathway after oxidativestress may be mediated by MBL binding to vascular endothelialcytokeratins, and not to glycoconjugates (Collard, C. D., et al., Am. J.Pathol. 159:1045-1054, 2001). Other studies have implicated theclassical and alternative pathways in the pathogenesis ofischemia/reperfusion injury and the role of the lectin pathway in thisdisease remains controversial (Riedermann, N. C., et al., Am. J. Pathol.162:363-367, 2003).

In contrast to the classical and lectin pathways, no initiators of thealternative pathway have been found to fulfill the recognition functionsthat C1q and lectins perform in the other two pathways. Currently it iswidely accepted that the alternative pathway is spontaneously triggeredby foreign or other abnormal surfaces (bacteria, yeast, virally infectedcells, or damaged tissue). There are four plasma proteins directlyinvolved in the alternative pathway: C3, factors B and D, and properdin.Proteolytic generation of C3b from native C3 is required for thealternative pathway to function. Since the alternative pathway C3convertase (C3bBb) contains C3b as an essential subunit, the questionregarding the origin of the first C3b via the alternative pathway haspresented a puzzling problem and has stimulated considerable research.

C3 belongs to a family of proteins (along with C4 and α-2 macroglobulin)that contain a rare posttranslational modification known as a thioesterbond. The thioester group is composed of a glutamine whose terminalcarbonyl group is bound to the sulfhydryl group of a cysteine threeamino acids away. This bond is unstable and the electrophilic carbonylgroup of glutamine can form a covalent bond with other molecules viahydroxyl or amino groups. The thioester bond is reasonably stable whensequestered within a hydrophobic pocket of intact C3. However,proteolytic cleavage of C3 to C3a and C3b results in exposure of thehighly reactive thioester bond on C3b and by this mechanism C3bcovalently attaches to a target. In addition to its well-documented rolein covalent attachment of C3b to complement targets, the C3 thioester isalso thought to have a pivotal role in triggering the alternativepathway. According to the widely accepted “tick-over theory”, thealternative pathway is initiated by the generation of a fluid-phaseconvertase, iC3Bb, which is formed from C3 with hydrolyzed thioester(iC3; C3(H₂O)) and factor B (Lachmann, P. J., et al., Springer Semin.Immunopathol. 7:143-162, 1984). The C3b-like iC3 is generated fromnative C3 by a slow spontaneous hydrolysis of the internal thioester inthe protein (Pangburn, M. K., et al., J. Exp. Med. 154:856-867, 1981).Through the activity of the iC3Bb convertase, C3b molecules aredeposited on the target surface thereby initiating the alternativepathway.

Very little is known about the initiators of activation of thealternative pathway. Activators are thought to include yeast cell walls(zymosan), many pure polysaccharides, rabbit erythrocytes, certainimmunoglobulins, viruses, fungi, bacteria, animal tumor cells,parasites, and damaged cells. The only feature common to theseactivators is the presence of carbohydrate, but the complexity andvariety of carbohydrate structures has made it difficult to establishthe shared molecular determinants, which are recognized.

The alternative pathway can also provide a powerful amplification loopfor the lectin/classical pathway C3 convertase (C4b2b) since any C3bgenerated can participate with factor B in forming additionalalternative pathway C3 convertase (C3bBb). The alternative pathway C3convertase is stabilized by the binding of properdin. Properdin extendsthe alternative pathway C3 convertase half-life six to ten fold.Addition of C3b to the C3 convertase leads to the formation of thealternative pathway C5 convertase.

All three pathways (i.e., the classical, lectin and alternative) havebeen thought to converge at C5, which is cleaved to form products withmultiple proinflammatory effects. The converged pathway has beenreferred to as the terminal complement pathway. C5a is the most potentanaphylatoxin, inducing alterations in smooth muscle and vascular tone,as well as vascular permeability. It is also a powerful chemotaxin andactivator of both neutrophils and monocytes. C5a-mediated cellularactivation can significantly amplify inflammatory responses by inducingthe release of multiple additional inflammatory mediators, includingcytokines, hydrolytic enzymes, arachidonic acid metabolites and reactiveoxygen species. C5 cleavage leads to the formation of C5b-9, also knownas the membrane attack complex (MAC). There is now strong evidence thatsublytic MAC deposition may play an important role in inflammation inaddition to its role as a lytic pore-forming complex.

SUMMARY

This summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This summary is not intended to identify key features ofthe claimed subject matter, nor is it intended to be used as an aid indetermining the scope of the claimed subject matter.

In one aspect, the present invention provides a method of inhibiting theadverse effects of MASP-2-dependent complement activation in a livingsubject. The method includes the step of administering to a subject inneed thereof, an amount of a MASP-2 inhibitory agent effective toinhibit MASP-2-dependent complement activation. In this context, thephrase “MASP-2-dependent complement activation” refers to alternativepathway complement activation that occurs via the lectin-dependentMASP-2 system. In another aspect of the invention, the MASP-2 inhibitoryagent inhibits complement activation via the lectin-dependent MASP-2system without substantially inhibiting complement activation via theclassical or C1q-dependent system, such that the C1q-dependent systemremains functional.

In some embodiments of these aspects of the invention, the MASP-2inhibitory agent is an anti-MASP-2 antibody or fragment thereof Infurther embodiments, the anti-MASP-2 antibody has reduced effectorfunction. In some embodiments, the MASP-2 inhibitory agent is a MASP-2inhibitory peptide or a non-peptide MASP-2 inhibitor.

In another aspect, the present invention provides compositions forinhibiting the adverse effects of MASP-2-dependent complementactivation, comprising a therapeutically effective amount of a MASP-2inhibitory agent and a pharmaceutically acceptable carrier. Methods arealso provided for manufacturing a medicament for use in inhibiting theadverse effects of MASP-2-dependent complement activation in livingsubjects in need thereof, comprising a therapeutically effective amountof a MASP-2 inhibitory agent in a pharmaceutical carrier. Methods arealso provided for manufacturing medicaments for use in inhibitingMASP-2-dependent complement activation for treatment of each of theconditions, diseases and disorders described herein below.

The methods, compositions and medicaments of the invention are usefulfor inhibiting the adverse effects of MASP-2-dependent complementactivation in vivo in mammalian subjects, including humans sufferingfrom an acute or chronic pathological condition or injury as furtherdescribed herein. Such conditions and injuries include withoutlimitation MASP-2 mediated complement activation in associatedautoimmune disorders and/or inflammatory conditions.

In another aspect of the invention methods are provided for inhibitingMASP-2-dependent complement activation in a subject suffering from, orat risk for developing, a coagulation disorder, such as a complementmediated coagulation disorder, or coagulopathy, by administering atherapeutically effective amount of a MASP-2 inhibitory agent in apharmaceutical carrier to such a subject. Conditions subject totreatment in accordance with the present invention include, by way ofnon-limiting example, disseminated intravascular coagulation (“DIC”),also referred to as consumptive coagulopathy.

In one aspect of the invention, methods are provided for inhibitingMASP-2-dependent complement activation in a subject suffering from, orat risk for developing, a coagulation disorder, comprising administeringto the subject an amount of a MASP-2 inhibitory agent effective toinhibit MASP-2-dependent complement activation.

In another aspect of the invention, methods are provided for inhibitingMASP-2-dependent complement activation in a subject suffering from, orat risk for developing, a coagulation disorder, comprising administeringto the subject an amount of a MASP-2 inhibitory agent effective toselectively inhibit MASP-2-dependent complement activation withoutsubstantially inhibiting C1q-dependent complement activation.

In another aspect of the invention, methods are provided formanufacturing a medicament for use in inhibiting the effects ofMASP-2-dependent complement activation in living subjects suffering froma complement mediated coagulation disorder, comprising combining atherapeutically effective amount of a MASP-2 inhibitory agent in apharmaceutical carrier.

In another aspect of the invention, methods are provided for treating,preventing, or reducing the severity of disseminated intravascularcoagulation in a subject in need thereof, comprising administering tothe subject a composition comprising an amount of a MASP-2 inhibitoryagent effective to inhibit MASP-2 dependent complement activation.

DESCRIPTION OF THE DRAWINGS

The foregoing aspects and many of the attendant advantages of thisinvention will become more readily appreciated as the same become betterunderstood by reference to the following detailed description, whentaken in conjunction with the accompanying drawings, wherein:

FIG. 1 is a flowchart illustrating the new discovery that thealternative complement pathway requires lectin pathway-dependent MASP-2activation for complement activation;

FIG. 2 is a diagram illustrating the genomic structure of human MASP-2;

FIG. 3A is a schematic diagram illustrating the domain structure ofhuman MASP-2 protein;

FIG. 3B is a schematic diagram illustrating the domain structure ofhuman MAp19 protein;

FIG. 4 is a diagram illustrating the murine MASP-2 knockout strategy;

FIG. 5 is a diagram illustrating the human MASP-2 minigene construct;

FIG. 6A presents results demonstrating that MASP-2-deficiency leads tothe loss of lectin-pathway-mediated C4 activation as measured by lack ofC4b deposition on mannan;

FIG. 6B presents results demonstrating that MASP-2-deficiency leads tothe loss of lectin-pathway-mediated C4 activation as measured by lack ofC4b deposition on zymosan;

FIG. 6C presents results demonstrating the relative C4 activation levelsof serum samples obtained from MASP-2+/−; MASP-2−/− and wild-typestrains as measure by C4b deposition on mannan and on zymosan;

FIG. 7A presents results demonstrating that MASP-2-deficiency leads tothe loss of both lectin-pathway-mediated and alternative pathwaymediated C3 activation as measured by lack of C3b deposition on mannan;

FIG. 7B presents results demonstrating that MASP-2-deficiency leads tothe loss of both lectin-pathway-mediated and alternative pathwaymediated C3 activation as measured by lack of C3b deposition on zymosan;

FIG. 8 presents results demonstrating that the addition of murinerecombinant MASP-2 to MASP-2−/− serum samples recoverslectin-pathway-mediated C4 activation in a protein concentrationdependant manner, as measured by C4b deposition on mannan;

FIG. 9 presents results demonstrating that the classical pathway isfunctional in the MASP-2−/− strain;

FIG. 10 presents results demonstrating that the MASP-2-dependentcomplement activation system is activated in the ischemia/reperfusionphase following abdominal aortic aneurysm repair;

FIG. 11A presents results demonstrating that anti-MASP-2 Fab2 antibody#11 inhibits C3 convertase formation, as described in Example 24;

FIG. 11B presents results demonstrating that anti-MASP-2 Fab2 antibody#11 binds to native rat MASP-2, as described in Example 24;

FIG. 11C presents results demonstrating that anti-MASP-2 Fab2 antibody#41 inhibits C4 cleavage, as described in Example 24;

FIG. 12 presents results demonstrating that all of the anti-MASP-2 Fab2antibodies tested that inhibited C3 convertase formation also were foundto inhibit C4 cleavage, as described in Example 24;

FIG. 13 is a diagram illustrating the recombinant polypeptides derivedfrom rat MASP-2 that were used for epitope mapping of the anti-MASP-2blocking Fab2 antibodies, as described in Example 25;

FIG. 14 presents results demonstrating the binding of anti-MASP-2 Fab2#40 and #60 to rat MASP-2 polypeptides, as described in Example 25;

FIG. 15 presents results demonstrating the blood urea nitrogen clearancefor wild type (+/+) and MASP-2 (−/−) mice at 24 and 48 hours afterreperfusion in a renal ischemia/reperfusion injury model, as describedin Example 26;

FIG. 16A presents results demonstrating the infarct size for wild type(+/+) and reduced infarct size in MASP-2 (−/−) mice after injury in acoronary artery occlusion and reperfusion model, as described in Example27;

FIG. 16B presents results showing the distribution of the individualanimals tested in the coronary artery occlusion and reperfusion model,as described in Example 27;

FIG. 17A presents results showing the baseline VEGF protein levels inRPE-choroid complex isolated from wild type (+/+) and MASP-2 (−/−) mice,as described in Example 28;

FIG. 17B presents results showing the VEGF protein levels in RPE-choroidcomplex at day 3 in wild type (+/+) and MASP-2 (−/−) mice followinglaser induced injury in a macular degeneration model, as described inExample 28;

FIG. 18 presents results showing the mean choroidal neovascularization(CNV) volume at day seven following laser induced injury in wild type(+/+) and MASP-2 (−/−) mice, as described in Example 28;

FIG. 19 presents results showing the mean clinical arthritis score ofwild type (+/+) and MASP-2 (−/−) mice over time following Col2mAb-induced rheumatoid arthritis, as described in Example 29;

FIG. 20A is a diagram showing the targeted disruption of the sMAP(Map19) gene, as described in Example 30;

FIG. 20B presents Southern blot analysis of genomic DNA isolated fromoffspring derived from mating male sMAP (−/−) chimeric mice with femaleC57BL/6 mice, as described in Example 30;

FIG. 20C presents PCR genotyping analysis of wild type (+/+) and sMAP(−/−) mice, as described in Example 30;

FIG. 21A presents Northern blot analysis of sMAP and MASP-2 mRNA in sMAP(−/−) mice, as described in Example 30;

FIG. 21B presents quantitative RT-PCR analysis of cDNA encoding MASP-2H-chain, MASP-2 L-chain and sMAP, in wild type (+/+) and sMAP (−/−)mice, as described in Example 30;

FIG. 22A presents an immunoblot of sMAP (−/−), i.e., MAp19 (−/−),demonstrating deficiency of MASP-2 and sMAP in mouse serum, as describedin Example 30;

FIG. 22B presents results demonstrating that MASP-2 and sMAP weredetected in the MBL-MASP-sMAP complex, as described in Example 30;

FIG. 23A presents results showing C4 deposition on mannan-coated wellsin wild type (+/+) and sMAP (−/−) mouse serum, as described in Example30;

FIG. 23B presents results showing C3 deposition on mannan-coated wellsin wild type (+/+) and sMAP (−/−) mouse serum, as described in Example30;

FIG. 24A presents results showing reconstitution of the MBL-MASP-sMAPcomplex in sMAP (−/−) serum, as described in Example 30;

FIGS. 24B-D present results showing competitive binding of rsMAP andMASP-2i to MBL, as described in Example 30;

FIGS. 25A-B present results showing restoration of the C4 depositionactivity by the addition of rMASP-2, but not rsMAP, as described inExample 30;

FIGS. 26A-B present results showing reduction of the C4 depositionactivity by addition of rsMAP, as described in Example 30;

FIGS. 27A-C presents results showing that MASP-2 is responsible for theC4 bypass activation of C3, as described in Example 31;

FIGS. 28A and 28B present dose response curves for the inhibition of C4bdeposition (FIG. 28A) and the inhibition of thrombin activationfollowing the administration of a MASP-2 Fab2 antibody in normal ratserum, as described in Example 32;

FIGS. 29A and 29B present measured platelet aggregation (expressed asaggregate area) in MASP-2 (−/−) mice (FIG. 29B) as compared to plateletaggregation in untreated wild type mice and wild type mice in which thecomplement pathway is inhibited by depletory agent cobra venom factor(CVF) and a terminal pathway inhibitor (C5aR antagonist) (FIG. 29A) in alocalized Schwartzman reaction model of disseminated intravascularcoagulation, as described in Example 33;

FIGS. 30A-30C illustrate the results of an investigation of C3 turn-overin C4−/− plasma in assays specific for either the classical or thelectin pathway activation route;

FIG. 31A graphically illustrates the mean area-at-risk (AAR) and infarctvolumes (INF) as a percentage of total myocardial volumes in WT (+/+)and MASP-2 (−/−) mice after undergoing left anterior descending coronaryartery occlusion and reperfusion, as described in Example 34;

FIG. 31B graphically illustrates the relationship between infarct volume(INF) plotted against the mean area-at-risk (AAR) as a percentage ofleft ventricle myocardial volume in WT (+/+) and MASP-2 (−/−) mice afterundergoing artery occlusion and reperfusion, as described in Example 34;

FIG. 31C graphically illustrates the infarct volume (INF) in thebuffer-perfused hearts of WT (+/+) and MASP-2 (−/−) mice prepared inaccordance with the Langendorff isolated-perfused mouse heart model, inwhich global ischemia and reperfusion was carried out in the absence ofserum, as described in Example 34;

FIG. 31D graphically illustrates the relationship between infarct volume(INF) and risk zone in the buffer-perfused hearts of WT (+/+) and MASP-2(−/−) mice prepared in accordance with the Langendorff isolated-perfusedmouse heart model, as described in Example 34;

FIG. 32 graphically illustrates the blood urea nitrogen (BUN) levelsmeasured in either WT (+/+) (B6) or MASP-2 (−/−) transplant recipientmice of WT (+/+) donor kidneys, as described in Example 35;

FIG. 33 graphically illustrates the percentage survival of WT (+/+) andMASP-2 (−/−) mice as a function of the number of days after microbialinfection in the cecal ligation and puncture (CLP) model, as describedin Example 36;

FIG. 34 graphically illustrates the number of bacteria measured in WT(+/+) and MASP-2 (−/−) after microbial infection in the cecal ligationand puncture (CLP) model, as described in Example 36;

FIG. 35 is a Kaplan-Mayer plot illustrating the percent survival of WT(+/+), MASP-2 (−/−) and C3 (−/−) mice six days after challenge withintranasal administration of Pseudomonas aeruginosa, as described inExample 37;

FIG. 36 graphically illustrates the level of C4b deposition, measured as% of control, in samples taken at various time points after subcutaneousdosing of either 0.3 mg/kg or 1.0 mg/kg of mouse anti-MASP-2 monoclonalantibody in WT mice, as described in Example 38;

FIG. 37 graphically illustrates the level of C4b deposition, measured as% of control, in samples taken at various time points after ip dosing of0.6 mg/kg of mouse anti-MASP-2 monoclonal antibody in WT mice, asdescribed in Example 38;

FIG. 38 graphically illustrates the mean choroidal neovascularization(CNV) volume at day seven following laser induced injury in WT (+/+)mice pre-treated with a single ip injection of 0.3 mg/kg or 1.0 mg/kgmouse anti-MASP-2 monoclonal antibody; as described in Example 39;

FIG. 39A graphically illustrates the percent survival of MASP-2 (−/−)and WT (+/+) mice after infection with 5×10⁸/100 μl cfu N. meningitidis,as described in Example 40;

FIG. 39B graphically illustrates the log cfu/ml of N. meningitidisrecovered at different time points in blood samples taken from theMASP-2 KO (−/−) and WT (+/+) mice infected with 5×10⁸ cfu/100 μl N.meningitidis, as described in Example 40;

FIG. 40A graphically illustrates the percent survival of MASP-2 KO (−/−)and WT (+/+) mice after infection with 2×10⁸ cfu/100 μl N. meningitidis,as described in Example 40;

FIG. 40B graphically illustrates the log cfu/ml of N. meningitidisrecovered at different time points in blood samples taken from the WT(+/+) mice infected with 2×10⁸ cfu/100 μl N. meningitidis, as describedin Example 40; and

FIG. 40C graphically illustrates the log cfu/ml of N. meningitidisrecovered at different time points in blood samples taken from theMASP-2 (−/−) mice infected with 2×10⁸ cfu/100 μl N. meningitidis, asdescribed in Example 40.

DESCRIPTION OF THE SEQUENCE LISTING

-   -   SEQ ID NO:1 human MAp19 cDNA    -   SEQ ID NO:2 human MAp19 protein (with leader)    -   SEQ ID NO:3 human MAp19 protein (mature)    -   SEQ ID NO:4 human MASP-2 cDNA    -   SEQ ID NO:5 human MASP-2 protein (with leader)    -   SEQ ID NO:6 human MASP-2 protein (mature)    -   SEQ ID NO:7 human MASP-2 gDNA (exons 1-6)

Antigens: (In Reference to the MASP-2 Mature Protein)

-   -   SEQ ID NO:8 CUBI sequence (aa 1-121)    -   SEQ ID NO:9 CUBEGF sequence (aa 1-166)    -   SEQ ID NO:10 CUBEGFCUBII (aa 1-293)    -   SEQ ID NO:11 EGF region (aa 122-166)    -   SEQ ID NO:12 serine protease domain (aa 429-671)    -   SEQ ID NO:13 serine protease domain inactive (aa 610-625 with        Ser618 to Ala mutation)    -   SEQ ID NO:14 TPLGPKWPEPVFGRL (CUB1 peptide)    -   SEQ ID NO:15 TAPPGYRLRLYFTHFDLELSHLCEYDFVKLSSGAKVLATLCGQ (CUBI        peptide)    -   SEQ ID NO:16 TFRSDYSN (MBL binding region core)    -   SEQ ID NO:17 FYSLGSSLDITFRSDYSNEKPFTGF (MBL binding region)    -   SEQ ID NO:18 IDECQVAPG (EGF PEPTIDE)    -   SEQ ID NO:19 ANMLCAGLESGGKDSCRGDSGGALV (serine protease binding        core)Detailed Description

Peptide Inhibitors:

-   -   SEQ ID NO:20 MBL full length cDNA    -   SEQ ID NO:21 MBL full length protein    -   SEQ ID NO:22 OGK-X-GP (consensus binding)    -   SEQ ID NO:23 OGKLG    -   SEQ ID NO:24 GLR GLQ GPO GKL GPO G    -   SEQ ID NO:25 GPO GPO GLR GLQ GPO GKL GPO GPO GPO

SEQ ID NO: 26  GKDGRDGTKGEKGEPGQGLRGLQGPOGKLGPOG SEQ ID NO: 27 GAOGSOGEKGAOGPQGPOGPOGKMGPKGEOGDO (human h-ficolin) SEQ ID NO: 28GCOGLOGAOGDKGEAGTNGKRGERGPOGPOGKAGPOGPNGA

-   -   OGEO (human ficolin p35)    -   SEQ ID NO:29 LQRALEILPNRVTIKANRPFLVFI (C4 cleavage site)        EXPRESSION INHIBITORS:    -   SEQ ID NO:30 cDNA of CUBI-EGF domain (nucleotides 22-680 of SEQ        ID NO:4)

SEQ ID NO: 31 5′ CGGGCACACCATGAGGCTGCTGACCCTCCTGGGC 3′

-   -   Nucleotides 12-45 of SEQ ID NO:4 including the MASP-2        translation start site (sense)

SEQ ID NO: 32 5′GACATTACCTTCCGCTCCGACTCCAACGAGAAG3′

-   -   Nucleotides 361-396 of SEQ ID NO:4 encoding a region comprising        the MASP-2 MBL binding site (sense)

SEQ ID NO: 33 5′AGCAGCCCTGAATACCCACGGCCGTATCCCAAA3′

-   -   Nucleotides 610-642 of SEQ ID NO:4 encoding a region comprising        the CUBII domain

Cloning Primers:

SEQ ID NO: 34 CGGGATCCATGAGGCTGCTGACCCTC (5′ PCR for CUB) SEQ ID NO: 35GGAATTCCTAGGCTGCATA (3′ PCR FOR CUB) SEQ ID NO: 36 GGAATTCCTACAGGGCGCT(3′ PCR FOR CUBIEGF) SEQ ID NO: 37 GGAATTCCTAGTAGTGGAT  (3′PCR FOR CUBIEGFCUBII)

-   -   SEQ ID NOS:38-47 are cloning primers for humanized antibody    -   SEQ ID NO:48 is 9 aa peptide bond

EXpression Vector:

-   -   SEQ ID NO:49 is the MASP-2 minigene insert    -   SEQ ID NO: 50 is the murine MASP-2 cDNA    -   SEQ ID NO: 51 is the murine MASP-2 protein (w/leader)    -   SEQ ID NO: 52 is the mature murine MASP-2 protein    -   SEQ ID NO: 53 the rat MASP-2 cDNA    -   SEQ ID NO: 54 is the rat MASP-2 protein (w/ leader)    -   SEQ ID NO: 55 is the mature rat MASP-2 protein    -   SEQ ID NO: 56-59 are the oligonucleotides for site-directed        mutagenesis of human MASP-2 used to generate human MASP-2A    -   SEQ ID NO: 60-63 are the oligonucleotides for site-directed        mutagenesis of murine MASP-2 used to generate murine MASP-2A    -   SEQ ID NO: 64-65 are the oligonucleotides for site-directed        mutagenesis of rat MASP-2 used to generate rat MASP-2A

DETAILED DESCRIPTION

The present invention is based upon the surprising discovery by thepresent inventors that MASP-2 is needed to initiate alternativecomplement pathway activation. Through the use of a knockout mouse modelof MASP-2−/−, the present inventors have shown that it is possible toinhibit alternative complement pathway activation via the lectinmediated MASP-2 pathway while leaving the classical pathway intact, thusestablishing the lectin-dependent MASP-2 activation as a requirement foralternative complement activation in absence of the classical pathway.The present invention also describes the use of MASP-2 as a therapeutictarget for inhibiting cellular injury associated with lectin-mediatedalternative complement pathway activation while leaving the classical(C1q-dependent) pathway component of the immune system intact.

I. DEFINITIONS

Unless specifically defined herein, all terms used herein have the samemeaning as would be understood by those of ordinary skill in the art ofthe present invention. The following definitions are provided in orderto provide clarity with respect to the terms as they are used in thespecification and claims to describe the present invention.

As used herein, the term “MASP-2-dependent complement activation” refersto alternative pathway complement activation that occurs vialectin-dependent MASP-2 activation.

As used herein, the term “alternative pathway” refers to complementactivation that is triggered, for example, by zymosan from fungal andyeast cell walls, lipopolysaccharide (LPS) from Gram negative outermembranes, and rabbit erythrocytes, as well as from many purepolysaccharides, rabbit erythrocytes, viruses, bacteria, animal tumorcells, parasites and damaged cells, and which has traditionally beenthought to arise from spontaneous proteolytic generation of C3b fromcomplement factor C3.

As used herein, the term “lectin pathway” refers to complementactivation that occurs via the specific binding of serum and non-serumcarbohydrate-binding proteins including mannan-binding lectin (MBL) andthe ficolins. As used herein, the term “classical pathway” refers tocomplement activation that is triggered by antibody bound to a foreignparticle and requires binding of the recognition molecule C1q.

As used herein, the term “MASP-2 inhibitory agent” refers to any agentthat binds to or directly interacts with MASP-2 and effectively inhibitsMASP-2-dependent complement activation, including anti-MASP-2 antibodiesand MASP-2 binding fragments thereof, natural and synthetic peptides,small molecules, soluble MASP-2 receptors, expression inhibitors andisolated natural inhibitors, and also encompasses peptides that competewith MASP-2 for binding to another recognition molecule (e.g., MBL,H-ficolin, M-ficolin, or L-ficolin) in the lectin pathway, but does notencompass antibodies that bind to such other recognition molecules.MASP-2 inhibitory agents useful in the method of the invention mayreduce MASP-2-dependent complement activation by greater than 20%, suchas greater than 50%, such as greater than 90%. In one embodiment, theMASP-2 inhibitory agent reduces MASP-2-dependent complement activationby greater than 90% (i.e., resulting in MASP-2 complement activation ofonly 10% or less).

As used herein, the term “antibody” encompasses antibodies and antibodyfragments thereof, derived from any antibody-producing mammal (e.g.,mouse, rat, rabbit, and primate including human), that specifically bindto MASP-2 polypeptides or portions thereof. Exemplary antibodies includepolyclonal, monoclonal and recombinant antibodies; multispecificantibodies (e.g., bispecific antibodies); humanized antibodies; murineantibodies; chimeric, mouse-human, mouse-primate, primate-humanmonoclonal antibodies; and anti-idiotype antibodies, and may be anyintact molecule or fragment thereof.

As used herein, the term “antibody fragment” refers to a portion derivedfrom or related to a full-length anti-MASP-2 antibody, generallyincluding the antigen binding or variable region thereof. Illustrativeexamples of antibody fragments include Fab, Fab′, F(ab)₂, F(ab′)₂ and Fvfragments, scFv fragments, diabodies, linear antibodies, single-chainantibody molecules and multispecific antibodies formed from antibodyfragments.

As used herein, a “single-chain Fv” or “scFv” antibody fragmentcomprises the V_(H) and V_(L) domains of an antibody, wherein thesedomains are present in a single polypeptide chain. Generally, the Fvpolypeptide further comprises a polypeptide linker between the V_(H) andV_(L) domains, which enables the scFv to form the desired structure forantigen binding.

As used herein, a “chimeric antibody” is a recombinant protein thatcontains the variable domains and complementarity-determining regionsderived from a non-human species (e.g., rodent) antibody, while theremainder of the antibody molecule is derived from a human antibody.

As used herein, a “humanized antibody” is a chimeric antibody thatcomprises a minimal sequence that conforms to specificcomplementarity-determining regions derived from non-humanimmunoglobulin that is transplanted into a human antibody framework.Humanized antibodies are typically recombinant proteins in which onlythe antibody complementarity-determining regions are of non-humanorigin.

As used herein, the term “mannan-binding lectin” (“MBL”) is equivalentto mannan-binding protein (“MBP”).

As used herein, the “membrane attack complex” (“MAC”) refers to acomplex of the terminal five complement components (C5-C9) that insertsinto and disrupts membranes. Also referred to as C5b-9.

As used herein, “a subject” includes all mammals, including withoutlimitation humans, non-human primates, dogs, cats, horses, sheep, goats,cows, rabbits, pigs and rodents.

As used herein, the amino acid residues are abbreviated as follows:alanine (Ala;A), asparagine (Asn;N), aspartic acid (Asp;D), arginine(Arg;R), cysteine (Cys;C), glutamic acid (Glu;E), glutamine (Gln;Q),glycine (Gly;G), histidine (His;H), isoleucine (Ile;I), leucine (Leu;L),lysine (Lys;K), methionine (Met;M), phenylalanine (Phe;F), proline(Pro;P), serine (Ser;S), threonine (Thr;T), tryptophan (Trp;W), tyrosine(Tyr;Y), and valine (Val;V).

In the broadest sense, the naturally occurring amino acids can bedivided into groups based upon the chemical characteristic of the sidechain of the respective amino acids. By “hydrophobic” amino acid ismeant either Ile, Leu, Met, Phe, Trp, Tyr, Val, Ala, Cys or Pro. By“hydrophilic” amino acid is meant either Gly, Asn, Gln, Ser, Thr, Asp,Glu, Lys, Arg or His. This grouping of amino acids can be furthersubclassed as follows. By “uncharged hydrophilic” amino acid is meanteither Ser, Thr, Asn or Gln. By “acidic” amino acid is meant either Gluor Asp. By “basic” amino acid is meant either Lys, Arg or His.

As used herein the term “conservative amino acid substitution” isillustrated by a substitution among amino acids within each of thefollowing groups: (1) glycine, alanine, valine, leucine, and isoleucine,(2) phenylalanine, tyrosine, and tryptophan, (3) serine and threonine,(4) aspartate and glutamate, (5) glutamine and asparagine, and (6)lysine, arginine and histidine.

The term “oligonucleotide” as used herein refers to an oligomer orpolymer of ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) ormimetics thereof. This term also covers those oligonucleobases composedof naturally-occurring nucleotides, sugars and covalent internucleoside(backbone) linkages as well as oligonucleotides havingnon-naturally-occurring modifications.

II. THE ALTERNATIVE PATHWAY: A NEW UNDERSTANDING

The alternative pathway of complement was first described by LouisPillemer and his colleagues in early 1950s based on studies in whichzymosan made from yeast cell walls was used to activate complement(Pillemer, L. et al., J. Exp. Med. 103:1-13, 1956; Lepow, I. H., J.Immunol. 125:471-478, 1980). Ever since then, zymosan is considered asthe canonical example of a specific activator of the alternative pathwayin human and rodent serum (Lachmann, P. J., et al., Springer Semin.Immunopathol. 7:143-162, 1984; Van Dijk, H., et al., J. Immunol. Methods85:233-243, 1985; Pangburn, M. K., Methods in Enzymol. 162:639-653,1988). A convenient and widely used assay for alternative pathwayactivation is to incubate serum with zymosan coated onto plastic wellsand to determine the amount of C3b deposition onto the solid phasefollowing the incubation. As expected, there is substantial C3bdeposition onto zymosan-coated wells following incubation with normalmouse serum (FIG. 7B). However, incubation of serum from homozygousMASP-2-deficient mice with zymosan-coated wells results in a substantialreduction in C3b deposition compared to that of normal serum.Furthermore, use of serum from mice heterozygous for deficiency in theMASP 2 gene in this assay results in levels of C3b deposition that areintermediate between those obtained with serum from homozygousMASP-2-deficient mice and normal mouse serum. Parallel results are alsoobtained using wells coated with mannan, another polysaccharide known toactivate the alternative pathway (FIG. 7A). Since the normal and MASP-2deficient mice share the same genetic background, except for the MASP 2gene, these unexpected results demonstrate that MASP-2 plays anessential role in activation of the alternative pathway.

These results provide strong evidence that the alternative pathway isnot an independent, stand-alone pathway of complement activation asdescribed in essentially all current medical textbooks and recent reviewarticles on complement. The current and widely held scientific view isthat the alternative pathway is activated on the surface of certainparticulate targets (microbes, zymosan, rabbit erythrocytes) through theamplification of spontaneous “tick-over” C3 activation. However, theabsence of significant alternative pathway activation in serum fromMASP-2 knockout mice by two well-known “activators” of the alternativepathway makes it unlikely that the “tick-over theory” describes animportant physiological mechanism for complement activation.

Since MASP-2 protease is known to have a specific and well-defined roleas the enzyme responsible for the initiation of the lectin complementcascade, these results implicate activation of the lectin pathway byzymosan and mannan as a critical first step for subsequent activation ofthe alternative pathway. C4b is an activation product generated by thelectin pathway but not by the alternative pathway. Consistent with thisconcept, incubation of normal mouse serum with zymosan- or mannan-coatedwells results in C4b deposition onto the wells and this C4b depositionis substantially reduced when the coated wells are incubated with serumfrom MASP-2-deficient mice (FIGS. 6A, 6B and 6C).

The alternative pathway, in addition to its widely accepted role as anindependent pathway for complement activation, can also provide anamplification loop for complement activation initially triggered via theclassical and lectin pathways (Liszewski, M. K. and J. P. Atkinson,1993, in Fundamental Immunology, Third Edition, edited by W.E. Paul,Raven Press, Ltd., New York; Schweinie, J. E., et al., J. Clin. Invest.84:1821-1829, 1989). In this alternative pathway-mediated amplificationmechanism, C3 convertase (C4b2b) generated by activation of either theclassical or lectin complement cascades cleaves C3 into C3a and C3b, andthereby provides C3b that can participate in forming C3bBb, thealternative pathway C3 convertase. The likely explanation for theabsence of alternative pathway activation in MASP-2 knockout serum isthat the lectin pathway is required for initial complement activation byzymosan, mannan, and other putative “activators” of the alternativepathway, while the alternative pathway plays a crucial role foramplifying complement activation. In other words, the alternativepathway is a feedforward amplification loop dependent upon the lectinand classical complement pathways for activation, rather than anindependent linear cascade.

Rather than the complement cascade being activated through threedistinct pathways (classical, alternative and lectin pathways) aspreviously envisioned, our results indicate that it is more accurate toview complement as being composed of two major systems, whichcorrespond, to a first approximation, to the innate (lectin) andacquired (classical) wings of the complement immune defense system.Lectins (MBP, M-ficolin, H-ficolin, and L-ficolin) are the specificrecognition molecules that trigger the innate complement system and thesystem includes the lectin pathway and the associated alternativepathway amplification loop. C1q is the specific recognition moleculethat triggers the acquired complement system and the system includes theclassical pathway and associated alternative pathway amplification loop.We refer to these two major complement activation systems as thelectin-dependent complement system and the C1q-dependent complementsystem, respectively.

In addition to its essential role in immune defense, the complementsystem contributes to tissue damage in many clinical conditions. Thus,there is a pressing need to develop therapeutically effective complementinhibitors to prevent these adverse effects. With recognition thatcomplement is composed of two major complement activation systems comesthe realization that it would be highly desirable to specificallyinhibit only the complement activation system causing a particularpathology without completely shutting down the immune defensecapabilities of complement. For example, in disease states in whichcomplement activation is mediated predominantly by the lectin-dependentcomplement system, it would be advantageous to specifically inhibit onlythis system. This would leave the C1q-dependent complement activationsystem intact to handle immune complex processing and to aid in hostdefense against infection.

The preferred protein component to target in the development oftherapeutic agents to specifically inhibit the lectin-dependentcomplement system is MASP-2. Of all the protein components of thelectin-dependent complement system (MBL, H-ficolin, M-ficolin,

L-ficolin, MASP-2, C2-C9, Factor B, Factor D, and properdin), onlyMASP-2 is both unique to the lectin-dependent complement system andrequired for the system to function. The lectins (MBL, H-ficolin,M-ficolin and L-ficolin) are also unique components in thelectin-dependent complement system. However, loss of any one of thelectin components would not necessarily inhibit activation of the systemdue to lectin redundancy. It would be necessary to inhibit all fourlectins in order to guarantee inhibition of the lectin-dependentcomplement activation system. Furthermore, since MBL and the ficolinsare also known to have opsonic activity independent of complement,inhibition of lectin function would result in the loss of thisbeneficial host defense mechanism against infection. In contrast, thiscomplement-independent lectin opsonic activity would remain intact ifMASP-2 was the inhibitory target. An added benefit of MASP-2 as thetherapeutic target to inhibit the lectin-dependent complement activationsystem is that the plasma concentration of MASP-2 is among the lowest ofany complement protein (≈500 ng/ml); therefore, correspondingly lowconcentrations of high-affinity inhibitors of MASP-2 may be required toobtain full inhibition (Moller-Kristensen, M., et al., J. ImmunolMethods 282:159-167, 2003).

III. ROLE OF MASP-2 IN VARIOUS DISEASES AND CONDITIONS AND THERAPEUTICMETHODS USING MASP-2 INHIBITORY AGENTS ISCHEMIA REPERFUSION INJURY

Ischemia reperfusion injury (I/R) occurs when blood flow is restoredafter an extended period of ischemia. It is a common source of morbidityand mortality in a wide spectrum of diseases. Surgical patients arevulnerable after aortic aneurysm repair, cardiopulmonary bypass,vascular reanastomosis in connection with, for example, organtransplants (e.g., heart, lung, liver, kidney) and digit/extremityreplantation, stroke, myocardial infarction and hemodynamicresuscitation following shock and/or surgical procedures. Patients withatherosclerotic diseases are prone to myocardial infarctions, strokes,and emboli-induced intestinal and lower-extremity ischemia. Patientswith trauma frequently suffer from temporary ischemia of the limbs. Inaddition, any cause of massive blood loss leads to a whole-body I/Rreaction.

The pathophysiology of FR injury is complex, with at least two majorfactors contributing to the process: complement activation andneutrophil stimulation with accompanying oxygen radical-mediated injury.In FR injury, complement activation was first described duringmyocardial infarction over 30 years ago, and has led to numerousinvestigations on the contribution of the complement system to I/Rtissue injury (Hill, J. H., et al., j. Exp. Med. 133:885-900, 1971).Accumulating evidence now points to complement as a pivotal mediator inI/R injury. Complement inhibition has been successful in limiting injuryin several animal models of I/R. In early studies, C3 depletion wasachieved following infusion of cobra venom factor, reported to bebeneficial during I/R in kidney and heart (Maroko, P. R., et al., 1978,J. Clin Invest. 61:661-670, 1978; Stein, S. H., et al., MinerElectrolyte Metab. 11:256-61, 1985). However, the soluble form ofcomplement receptor 1 (sCR1) was the first complement-specific inhibitorutilized for the prevention of myocardial I/R injury (Weisman, H. F., etal., Science 249:146-51, 1990). sCR1 treatment during myocardial I/Rattenuates infarction associated with decreased deposition of C5b-9complexes along the coronary endothelium and decreased leukocyteinfiltration after reperfusion.

In experimental myocardial I/R, C1 esterase inhibitor (C1 INH)administered before reperfusion prevents deposition of C1q andsignificantly reduced the area of cardiac muscle necrosis (Buerke, M.,et al., 1995, Circulation 91:393-402, 1995). Animals geneticallydeficient in C3 have less local tissue necrosis after skeletal muscle orintestinal ischaemia (Weiser, M. R., et al., J. Exp. Med. 183:2343-48,1996).

The membrane attack complex is the ultimate vehicle ofcomplement-directed injury and studies in CS-deficient animals haveshown decreased local and remote injury in models of I/R injury (Austen,W. G. Jr., et al., Surgery 126:343-48, 1999). An inhibitor of complementactivation, soluble Crry (complement receptor-related gene Y), has beenshown to be effective against injury when given both before and afterthe onset of murine intestinal reperfusion (Rehrig, S., et al., J.Immunol. 167:5921-27, 2001). In a model of skeletal muscle ischemia, theuse of soluble complement receptor 1 (sCR1) also reduced muscle injurywhen given after the start of reperfusion (Kyriakides, C., et al., Am.J. Physiol. Cell Physiol. 281:C244-30, 2001). In a porcine model ofmyocardial I/R, animals treated with monoclonal antibody (“MoAb”) to theanaphylatoxin C5a prior to reperfusion showed attenuated infarction(Amsterdam, E. A., et al., Am. J. Physiol. Heart Circ. Physiol.

268:H448-57, 1995). Rats treated with C5 MoAb demonstrated attenuatedinfarct size, neutrophil infiltration and apoptosis in the myocardium(Vakeva, A., et al., Circulation 97:2259-67, 1998). These experimentalresults highlight the importance of complement activation in thepathogenesis of I/R injury.

It is unclear which complement pathway (classical, lectin oralternative) is predominantly involved in complement activation in I/Rinjury. Weiser et al. demonstrated an important role of the lectinand/or classical pathways during skeletal I/R by showing that C3- orC4-knockout mice were protected against I/R injury based on asignificant reduction in vascular permeability (Weiser, M. R., et al.,J. Exp. Med. 183:2343-48, 1996). In contrast, renal I/R experiments withC4 knockout mice demonstrate no significant tissue protection, whileC3-, C5-, and C6-knockout mice were protected from injury, suggestingthat complement activation during renal I/R injury occurs via thealternative pathway (Zhou, W., et al., J. Clin. Invest. 105:1363-71,2000). Using factor D deficient mice, Stahl et al. recently presentedevidence for an important role of the alternative pathway in intestinalI/R in mice (Stahl, G., et al., Am. J. Pathol. 162:449-55, 2003). Incontrast, Williams et al.

suggested a predominant role of the classical pathway for initiation ofI/R injury in the intestine of mice by showing reduced organ stainingfor C3 and protection from injury in C4 and IgM (Rag1−/−) deficient mice(Williams, J. P., et al., J. Appl. Physiol. 86:938-42, 1999).

Treatment of rats in a myocardial FR model with monoclonal antibodiesagainst rat mannan-binding lectin (MBL) resulted in reduced postischemicreperfusion injury (Jordan, J. E., et al., Circulation 104:1413-18,2001). MBL antibodies also reduced complement deposition on endothelialcells in vitro after oxidative stress indicating a role for the lectinpathway in myocardial I/R injury (Collard, C. D., et al., Am. J. Pathol.156:1549-56, 2000). There is also evidence that I/R injury in someorgans may be mediated by a specific category of IgM, termed naturalantibodies, and activation of the classical pathway (Fleming, S. D., etal., J. Immunol. 169:2126-33, 2002; Reid, R. R., et al., J. Immunol.169:5433-40, 2002).

Several inhibitors of complement activation have been developed aspotential therapeutic agents to prevent morbidity and mortalityresulting from myocardial I/R complications. Two of these inhibitors,sCR1 (TP10) and humanized anti-CS scFv (Pexelizumab), have completedPhase II clinical trials. Pexelizumab has additionally completed a PhaseIII clinical trial. Although TP10 was well tolerated and beneficial topatients in early Phase I/II trials, results from a Phase II trialending in February 2002 failed to meet its primary endpoint. However,sub-group analysis of the data from male patients in a high-riskpopulation undergoing open-heart procedures demonstrated significantlydecreased mortality and infarct size. Administration of a humanizedanti-CS scFv decreased overall patient mortality associated with acutemyocardial infarction in the COMA and COMPLY Phase II trials, but failedto meet the primary endpoint (Mahaffey, K. W., et al., Circulation108:1176-83, 2003). Results from a recent Phase III anti-CS scFvclinical trial (PRIMO-CABG) for improving surgically induced outcomesfollowing coronary artery bypass were recently released. Although theprimary endpoint for this study was not reached, the study demonstratedan overall reduction in postoperative patient morbidity and mortality.

Dr. Walsh and colleagues have demonstrated that mice lacking MBL, andhence devoid of MBL-dependent lectin pathway activation but withfully-active classical complement pathways, are protected from cardiacreperfusion injury with resultant preservation of cardiac function(Walsh et al., J. Immunol. 175:541-46, 2005). Significantly, mice thatlack C1q, the recognition component of the classical complement pathway,but that have intact MBL complement pathway, are not protected frominjury. These results indicate that the lectin pathway has a major rolein the pathogenesis of myocardial reperfusion ischemic injury.

Complement activation is known to play an important role in tissueinjury associated with gastrointestinal ischemia-reperfusion (I/R).Using a murine model of GI/R, a recent study by Hart and colleaguesreports that mice genetically deficient in MBL are protected from gutinjury after gastrointestinal FR (Hart et al., J. Immunol. 174:6373-80,2005). Addition of recombinant MBL to MBL-deficient mice significantlyincreased injury compared to untreated MBL-deficient mice aftergastrointestinal FR. In contrast, mice that genetically lack C1q, theclassical pathway recognition component, are not protected from tissueinjury after gastrointestinal I/R.

Kidney I/R is an important cause of acute renal failure. The complementsystem appears to be essentially involved in renal I/R injury. In arecent study, de Vries and colleagues report that the lectin pathway isactivated in the course of experimental as well as clinical renal I/Rinjury (de Vries et al., Am. J. Path. 165:1677-88, 2004). Moreover, thelectin pathway precedes and co-localizes with complement C3, C6, and C9deposition in the course of renal I/R. These results indicate that thelectin pathway of complement activation is involved in renal I/R injury.

One aspect of the invention is thus directed to the treatment ofischemia reperfusion injuries by treating a subject experiencingischemic reperfusion with a therapeutically effective amount of a MASP-2inhibitory agent in a pharmaceutical carrier. The MASP-2 inhibitoryagent may be administered to the subject by intra-arterial, intravenous,intracranial, intramuscular, subcutaneous, or other parenteraladministration, and potentially orally for non-peptidergic inhibitors,and most suitably by intra-arterial or intravenous administration.Administration of the MASP-2 inhibitory compositions of the presentinvention suitably commences immediately after or as soon as possibleafter an ischemia reperfusion event. In instances where reperfusionoccurs in a controlled environment (e.g., following an aortic aneurismrepair, organ transplant or reattachment of severed or traumatized limbsor digits), the MASP-2 inhibitory agent may be administered prior toand/or during and/or after reperfusion. Administration may be repeatedperiodically as determined by a physician for optimal therapeuticeffect.

Athero Sclerosclerosis

There is considerable evidence that complement activation is involved inatherogenesis in humans. A number of studies have convincingly shownthat, although no significant complement activation takes place innormal arteries, complement is extensively activated in atheroscleroticlesions and is especially strong in vulnerable and ruptured plaques.Components of the terminal complement pathway are frequently found inhuman atheromas (Niculescu, F., et al., Mol. Immunol. 36:949-55.10-12,1999; Rus, H. G., et al., Immunol. Lett. 20:305-310, 1989; Torzewski,M., et al., Arterioscler. Thromb. Vasc. Biol. 18:369-378, 1998). C3 andC4 deposition in arterial lesions has also been demonstrated (Hansson,G. K., et al., Acta Pathol. Microbiol. Immunol. Scand. (A) 92:429-35,1984). The extent of C5b-9 deposition was found to correlate with theseverity of the lesion (Vlaicu, R., et al., Atherosclerosis 57:163-77,1985). Deposition of complement iC3b, but not C5b-9, was especiallystrong in ruptured and vulnerable plaques, suggesting that complementactivation may be a factor in acute coronary syndromes (Taskinen S., etal., Biochem. J. 367:403-12, 2002). In experimental atheroma in rabbits,complement activation was found to precede the development of lesions(Seifer, P. S., et al., Lab Invest. 60:747-54, 1989). In atheroscleroticlesions, complement is activated via the classic and alternativepathways, but there is little evidence, as yet, of complement activationvia the lectin pathway. Several components of the arterial wall maytrigger complement activation. The classical pathway of complement maybe activated by C-reactive protein (CRP) bound to enzymatically degradedLDL (Bhakdi, S., et al., Arterioscler. Thromb. Vasc. Biol. 19:2348-54,1999). Consistent with this view is the finding that the terminalcomplement proteins colocalize with CRP in the intima of early humanlesions (Torzewski, J., et al., Arterioscler. Thromb. Vasc. Biol.18:1386-92, 1998). Likewise, immunoglobulin M or IgG antibodies specificfor oxidized LDL within lesions may activate the classical pathway(Witztum, J. L., Lancet 344:793-95, 1994). Lipids isolated from humanatherosclerotic lesions have a high content of unesterified cholesteroland are able to activate the alternative pathway (Seifert P. S., et al.,J. Exp. Med. 172:547-57, 1990). Chlamydia pneumoniae, a Gram-negativebacteria frequently associated with atherosclerotic lesions, may alsoactivate the alternative pathway of complement (Campbell L. A., et al.,J. Infect. Dis. 172:585-8, 1995). Other potential complement activatorspresent in atherosclerotic lesions include cholesterol crystals and celldebris, both of which can activate the alternative pathway (Seifert, P.S., et al., Mol. Immunol. 24:1303-08, 1987).

Byproducts of complement activation are known to have many biologicalproperties that could influence the development of atheroscleroticlesions. Local complement activation may induce cell lysis and generateat least some of the cell debris found in the necrotic core of advancedlesions (Niculescu, F. et al., Mol. Immunol. 36:949-55.10-12, 1999).Sublytic complement activation could be a significant factorcontributing to smooth muscle cell proliferation and to monocyteinfiltration into the arterial intima during atherogenesis (TorzewskiJ., et al., Arterioscler. Thromb. Vasc. Biol. 18:673-77, 1996).Persistent activation of complement may be detrimental because it maytrigger and sustain inflammation. In addition to the infiltration ofcomplement components from blood plasma, arterial cells expressmessenger RNA for complement proteins and the expression of variouscomplement components is upregulated in atherosclerotic lesions(Yasojima, K., et al., Arterioscler. Thromb. Vasc. Biol. 21:1214-19,2001).

A limited number of studies on the influence of complement proteindeficiencies on atherogenesis have been reported. The results inexperimental animal models have been conflicting. In the rat, theformation of atherosclerotic-like lesions induced by toxic doses ofvitamin D was diminished in complement-depleted animals (Geertinger P.,et al., Acta. Pathol. Microbiol. Scand. (A) 78:284-88, 1970).Furthermore, in cholesterol-fed rabbits, complement inhibition either bygenetic C6 deficiency (Geertinger, P., et al., Artery 1:177-84, 1977;Schmiedt, W., et al., Arterioscl. Thromb. Vasc. Biol. 18:1790-1795,1998) or by anticomplement agent K-76 COONa (Saito, E., et al., J. DrugDev. 3:147-54, 1990) suppressed the development of atherosclerosiswithout affecting the serum cholesterol levels. In contrast, a recentstudy reported that C5 deficiency does not reduce the development ofatherosclerotic lesions in apolipoprotein E (ApoE) deficient mice(Patel, S., et al., Biochem. Biophys. Res. Commun. 286:164-70, 2001).However, in another study the development of atherosclerotic lesions inLDLR-deficient (ldlr-) mice with or without C3 deficiency was evaluated(Buono, C., et al., Circulation 105:3025-31, 2002). They found that thematuration of atheromas to atherosclerotic-like lesions depends in partof the presence of an intact complement system.

One aspect of the invention is thus directed to the treatment orprevention of atherosclerosis by treating a subject suffering from orprone to atherosclerosis with a therapeutically effective amount of aMASP-2 inhibitory agent in a pharmaceutical carrier. The MASP-2inhibitory agent may be administered to the subject by intra-arterial,intravenous, intrathecal, intracranial, intramuscular, subcutaneous orother parenteral administration, and potentially orally fornon-peptidergic inhibitors. Administration of the MASP-2 inhibitorycomposition may commence after diagnosis of atherosclerosis in a subjector prophylactically in a subject at high risk of developing such acondition. Administration may be repeated periodically as determined bya physician for optimal therapeutic effect.

Other Vascular Diseases and Conditions

The endothelium is largely exposed to the immune system and isparticularly vulnerable to complement proteins that are present inplasma. Complement-mediated vascular injury has been shown to contributeto the pathophysiology of several diseases of the cardiovascular system,including atherosclerosis (Seifert, P. S., et al., Atherosclerosis73:91-104, 1988), ischemia-reperfusion injury (Weisman, H. F., Science249:146-51, 1990) and myocardial infarction (Tada, T., et al., VirchowsArch 430:327-332, 1997). Evidence suggests that complement activationmay extend to other vascular conditions.

For example, there is evidence that complement activation contributes tothe pathogenesis of many forms of vasculitis, including:Henoch-Schonlein purpura nephritis, systemic lupuserythematosus-associated vasculitis, vasculitis associated withrheumatoid arthritis (also called malignant rheumatoid arthritis),immune complex vasculitis, and Takayasu's disease. Henoch-Schonleinpurpura nephritis is a form of systemic vasculitis of the small vesselswith immune pathogenesis, in which activation of complement through thelectin pathway leading to C5b-9-induced endothelial damage is recognizedas an important mechanism (Kawana, S., et al., Arch. Dermatol. Res.282:183-7, 1990; Endo, M., et al., Am J. Kidney Dis. 35:401-7, 2000).Systemic lupus erythematosus (SLE) is an example of systemic autoimmunediseases that affects multiple organs, including skin, kidneys, joints,serosal surfaces, and central nervous system, and is frequentlyassociated with severe vasculitis. IgG anti-endothelial antibodies andIgG complexes capable of binding to endothelial cells are present in thesera of patients with active SLE, and deposits of IgG immune complexesand complement are found in blood vessel walls of patients with SLEvasculitis (Cines, D. B., et al., J. Clin. Invest. 73:611-25, 1984).Rheumatoid arthritis associated with vasculitis, also called malignantrheumatoid arthritis (Tomooka, K., Fukuoka Igaku Zasshi 80:456-66,1989), immune-complex vasculitis, vasculitis associated with hepatitisA, leukocytoclastic vasculitis, and the arteritis known as Takayasu'sdisease, form another pleomorphic group of human diseases in whichcomplement-dependent cytotoxicity against endothelial and other celltypes plays a documented role (Tripathy, N. K., et al., J. Rheumatol.28:805-8, 2001).

Evidence also suggests that complement activation plays a role indilated cardiomyopathy. Dilated cardiomyopathy is a syndromecharacterized by cardiac enlargement and impaired systolic function ofthe heart. Recent data suggests that ongoing inflammation in themyocardium may contribute to the development of disease. C5b-9, theterminal membrane attack complex of complement, is known tosignificantly correlate with immunoglobulin deposition and myocardialexpression of TNF-alpha. In myocardial biopsies from 28 patients withdilated cardiomyopathy, myocardial accumulation of C5b-9 wasdemonstrated, suggesting that chronic immunoglobulin-mediated complementactivation in the myocardium may contribute in part to the progressionof dilated cardiomyopathy (Zwaka, T. P., et al., Am. J. Pathol.161(2):449-57, 2002).

One aspect of the invention is thus directed to the treatment of avascular condition, including cardiovascular conditions, cerebrovascularconditions, peripheral (e.g., musculoskeletal) vascular conditions,renovascular conditions, and mesenteric/enteric vascular conditions, byadministering a composition comprising a therapeutically effectiveamount of a MASP-2 inhibitory agent in a pharmaceutical carrier.Conditions for which the invention is believed to be suited include,without limitation: vasculitis, including Henoch-Schonlein purpuranephritis, systemic lupus erythematosus-associated vasculitis,vasculitis associated with rheumatoid arthritis (also called malignantrheumatoid arthritis), immune complex vasculitis, and Takayasu'sdisease; dilated cardiomyopathy; diabetic angiopathy; Kawasaki's disease(arteritis); and venous gas embolus (VGE). Also, given that complementactivation occurs as a result of luminal trauma and the foreign-bodyinflammatory response associated with cardiovascular interventionalprocedures, it is believed that the MASP-2 inhibitory compositions ofthe present invention may also be used in the inhibition of restenosisfollowing stent placement, rotational atherectomy and/or percutaneoustransluminal coronary angioplasty (PTCA), either alone or in combinationwith other restenosis inhibitory agents such as are disclosed in U.S.Pat. No. 6,492,332 to Demopulos.

The MASP-2 inhibitory agent may be administered to the subject byintra-arterial, intravenous, intramuscular, intrathecal, intracranial,subcutaneous or other parenteral administration, and potentially orallyfor non-peptidergic inhibitors. Administration may be repeatedperiodically as determined by a physician for optimal therapeuticeffect. For the inhibition of restenosis, the MASP-2 inhibitorycomposition may be administered before and/or during and/or after theplacement of a stent or the atherectomy or angioplasty procedure.Alternately, the MASP-2 inhibitory composition may be coated on orincorporated into the stent.

Gastrointestinal Disorders

Ulcerative colitis and Crohn's disease are chronic inflammatorydisorders of the bowel that fall under the banner of inflammatory boweldisease (IBD). IBD is characterized by spontaneously occurring, chronic,relapsing inflammation of unknown origin. Despite extensive researchinto the disease in both humans and experimental animals, the precisemechanisms of pathology remain to be elucidated. However, the complementsystem is believed to be activated in patients with IBD and is thoughtto play a role in disease pathogenesis (Kolios, G., et al.,Hepato-Gastroenterology 45:1601-9, 1998; Elmgreen, J., Dan. Med. Bull.33:222, 1986).

It has been shown that C3b and other activated complement products arefound at the luminal face of surface epithelial cells, as well as in themuscularis mucosa and submucosal blood vessels in IBD patients(Halstensen, T. S., et al., Immunol. Res. 10:485-92, 1991; Halstensen,T. S., et al., Gastroenterology 98:1264, 1990). Furthermore,polymorphonuclear cell infiltration, usually a result of C5a generation,characteristically is seen in the inflammatory bowel (Kohl, J., Mol.Immunol. 38:175, 2001). The multifunctional complement inhibitor K-76,has also been reported to produce symptomatic improvement of ulcerativecolitis in a small clinical study (Kitano, A., et al., Dis. Colon Rectum35:560, 1992), as well as in a model of carrageenan-induced colitis inrabbits (Kitano, A., et al., Clin. Exp. Immunol. 94:348-53, 1993).

A novel human C5a receptor antagonist has been shown to protect againstdisease pathology in a rat model of IBD (Woodruff, T. M., et al., J.Immunol. 171:5514-20, 2003). Mice that were genetically deficient indecay-accelerating factor (DAF), a membrane complement regulatoryprotein, were used in a model of IBD to demonstrate that DAF deficiencyresulted in markedly greater tissue damage and increased proinflammatorycytokine production (Lin, F., et al., J. Immunol. 172:3836-41, 2004).Therefore, control of complement is important in regulating guthomeostasis and may be a major pathogenic mechanism involved in thedevelopment of IBD.

The present invention thus provides methods for inhibitingMASP-2-dependent complement activation in subjects suffering frominflammatory gastrointestinal disorders, including but not limited topancreatitis, diverticulitis and bowel disorders including Crohn'sdisease, ulcerative colitis, and irritable bowel syndrome, byadministering a composition comprising a therapeutically effect amountof a MASP-2 inhibitory agent in a pharmaceutical carrier to a patientsuffering from such a disorder. The MASP-2 inhibitory agent may beadministered to the subject by intra-arterial, intravenous,intramuscular, subcutaneous, intrathecal, intracranial or otherparenteral administration, and potentially orally for non-peptidergicinhibitors. Administration may suitably be repeated periodically asdetermined by a physician to control symptoms of the disorder beingtreated.

Pulmonary Conditions

Complement has been implicated in the pathogenesis of many lunginflammatory disorders, including: acute respiratory distress syndrome(ARDS) (Ware, I., et al., N. Engl. J. Med. 342:1334-49, 2000);transfusion-related acute lung injury (TRALI) (Seeger, W., et al., Blood76:1438-44, 1990); ischemia/reperfusion acute lung injury (Xiao, F., etal., J. Appl. Physiol. 82:1459-65, 1997); chronic obstructive pulmonarydisease (COPD) (Marc, M. M., et al., Am. J. Respir. Cell Mol. Biol.(Epub ahead of print), Mar. 23, 2004); asthma (Krug, N., et al., Am. J.Respir. Crit. Care Med. 164:1841-43, 2001); Wegener's granulomatosis(Kalluri, R., et al., J. Am. Soc. Nephrol. 8:1795-800, 1997); andantiglomerular basement membrane disease (Goodpasture's disease) (Kondo,C., et al., Clin. Exp. Immunol. 124:323-9, 2001).

It is now well accepted that much of the pathophysiology of ARDSinvolves a dysregulated inflammatory cascade that begins as a normalresponse to an infection or other inciting event, but ultimately causessignificant autoinjury to the host (Stanley, T. P., Emerging TherapeuticTargets 2:1-16, 1998). Patients with ARDS almost universally showevidence of extensive complement activation (increased plasma levels ofcomplement components C3a and C5a), and the degree of complementactivation has been correlated with the development and outcome of ARDS(Hammerschmidt, D. F., et al., Lancet 1:947-49, 1980; Solomkin, J S., etal., J. Surgery 97:668-78, 1985).

Various experimental and clinical data suggest a role for complementactivation in the pathophysiology of ARDS. In animal models, systemicactivation of complement leads to acute lung injury with histopathologysimilar to that seen in human ARDS (Till, G. O., et al., Am. J. Pathol.129:44-53, 1987; Ward, P. A., Am. J. Pathol. 149:1081-86, 1996).Inhibiting the complement cascade by general complement depletion or byspecific inhibition of C5a confers protection in animal models of acutelung injury (Mulligan, M. S., et al., J. Clin. Invest. 98:503-512,1996). In rat models, sCR1 has a protective effect in complement- andneutrophil-mediated lung injury (Mulligan, M. S., Yeh, et al., J.Immunol. 148:1479-85, 1992). In addition, virtually all complementcomponents can be produced locally in the lung by type II alveolarcells, alveolar macrophages and lung fibroblasts (Hetland, G., et al.,Scand. J. Immunol. 24:603-8, 1986; Rothman, B. I., et al., J. Immunol.145:592-98, 1990). Thus the complement cascade is well positioned tocontribute significantly to lung inflammation and, consequently, to lunginjury in ARDS.

Asthma is, in essence, an inflammatory disease. The cardinal features ofallergic asthma include airway hyperresponsiveness to a variety ofspecific and nonspecific stimuli, excessive airway mucus production,pulmonary eosinophilia, and elevated concentration of serum IgE.Although asthma is multifactorial in origin, it is generally acceptedthat it arises as a result of inappropriate immunological responses tocommon environmental antigens in genetically susceptible individuals.The fact that the complement system is highly activated in the humanasthmatic lung is well documented (Humbles, A. A., et al., Nature406:998-01, 2002; van de Graf, E. A., et al., J. Immunol. Methods147:241-50, 1992). Furthermore, recent data from animal models andhumans provide evidence that complement activation is an importantmechanism contributing to disease pathogenesis (Karp, C. L., et al.,Nat. Immunol. 1:221-26, 2000; Bautsch, W., et al., J. Immunol.165:5401-5, 2000; Drouin, S. M., et al., J. Immunol. 169:5926-33, 2002;Walters, D. M., et al., Am. J. Respir. Cell Mol. Biol. 27:413-18, 2002).A role for the lectin pathway in asthma is supported by studies using amurine model of chronic fungal asthma. Mice with a genetic deficiency inmannan-binding lectin develop an altered airway hyperresponsivenesscompared to normal animals in this asthma model (Hogaboam, C. M., etal., J. Leukoc. Biol. 75:805-14, 2004).

Complement may be activated in asthma via several pathways, including:(a) activation through the classical pathway as a result ofallergen-antibody complex formation; (b) alternative pathway activationon allergen surfaces; (c) activation of the lectin pathway throughengagement of carbohydrate structures on allergens; and (d) cleavage ofC3 and C5 by proteases released from inflammatory cells. Although muchremains to be learned about the complex role played by complement inasthma, identification of the complement activation pathways involved inthe development of allergic asthma may provide a focus for developmentof novel therapeutic strategies for this increasingly important disease.

A number of studies using animal models have demonstrated a criticalrole for C3 and its cleavage product, C3a, in the development of theallergic phenotype. Drouin and colleagues used C3-deficient mice in theovalbumin (OVA)/Aspergillus fumigatus asthma model (Drouin et al., J.Immunol. 167:4141-45, 2001). They found that, when challenged withallergen, mice deficient in C3 exhibit strikingly diminished AHR andlung eosinophilia compared to matched wild type control mice.Furthermore, these C3-deficient mice had dramatically reduced numbers ofIL-4 producing cells and attenuated Ag-specific IgE and IgG1 responses.Taube and colleagues obtained similar results in the OVA model of asthmaby blocking complement activation at the level of C3 and C4 using asoluble recombinant form of the mouse complement receptor Crry (Taube etal., Am. J. Respir. Crit. Care Med. 168:1333-41, 2003). Humbles andcolleagues deleted the C3aR in mice to examine the role of C3a ineosinophil function (Humbles et al., Nature 406:998-1001, 2000). Usingthe OVA model of asthma, they observed near complete protection from thedevelopment of AHR to aerosolized methacholine. Drouin and colleagues(2002) have used C3aR-deficient mice in the OVA/A. fumigatus asthmamodel and demonstrated an attenuated allergic response very similar toC3-deficient animals with diminished AHR, eosinophil recruitment, TH2cytokine production, and mucus secretion in the lung, as well as reducedAg-specific IgE and IgG1 responses (Drouin et al., J. Immunol.169:5926-33, 2002). Bautsch and colleagues performed investigationsusing a strain of guinea pigs that have a natural deletion of C3aR(Bautsch et al., J. Immunol. 165:5401-05, 2000). Using an OVA model ofallergic asthma, they observed significant protection from airwaybronchoconstriction following antigen challenge.

A number of recent studies using animal models have demonstrated acritical role for C5 and its cleavage product C5a, in the development ofthe allergic phenotype. Abe and colleagues have reported evidence thatlinks C5aR activation to airway inflammation, cytokine production andairway responsiveness (Abe et al., J. Immunol. 167:4651-60, 2001). Intheir studies, inhibition of complement activation by soluble CR1,futhan (an inhibitor of complement activation) or synthetic hexapeptideC5a antagonist blocked the inflammatory response and airwayresponsiveness to methacholine. In studies using a blocking anti-C5monoclonal antibody Peng and colleagues found that C5 activationcontributed substantially to both airway inflammation and AHR in the OVAmodel of asthma (Peng et al., J. Clin. Invest. 115:1590-1600, 2005).Also, Baelder and colleagues reported that blockade of the C5aRsubstantially reduced AHR in the A. fumigatus model of asthma (Baelderet al., J. Immunol. 174:783-89, 2005). Furthermore, blockade of both theC3aR and the C5aR significantly reduced airway inflammation asdemonstrated by reduced numbers of neutrophils and eosinophils in BAL.

Although the previously listed studies highlight the importance ofcomplement factors C3 and C5 and their cleavage products in thepathogenesis of experimental allergic asthma, these studies provide noinformation about the contribution of each of the three complementactivation pathways since C3 and C5 are common to all three activationpathways. However, a recent study by Hogaboam and colleagues indicatesthat the lectin pathway may have a major role in the pathogenesis ofasthma (Hogaboam et al., J. Leukocyte Biol. 75:805-814, 2004). Thesestudies used mice genetically deficient in mannan-binding lectin-A(MBL-A), a carbohydrate binding protein that functions as therecognition component for activation of the lectin complement pathway.In a model of chronic fungal asthma, MBL-A(+/+) and MBL-A(−/−) A.fumigatus-sensitized mice were examined at days 4 and 28 after an i. t.challenge with A. fumigatus conidia. AHR in sensitized MBL-A(−/−) micewas significantly attenuated at both times after conidia challengecompared with the sensitized MBL-A (+/+) group. They found that lung TH2cytokine levels (IL-4, IL-5 and IL-13) were significantly lower in A.fumigatus-sensitized MBL-A(−/−) mice compared to the wild-type group atday 4 after conidia. Their results indicate that MBL-A and the lectinpathway have a major role in the development and maintenance of AHRduring chronic fungal asthma.

Results from a recent clinical study in which the association between aspecific MBL polymorphism and development of asthma provides furtherevidence that the lectin pathway may play an important pathological rolein this disease (Kaur et al., Clin. Experimental Immunol. 143:414-19,2006). Plasma concentrations of MBL vary widely between individuals, andthis is primarily attributable to the genetic polymorphisms within theMBL gene. They found that individuals who carry at least one copy of aspecific MBL polymorphism that up regulates MBL expression two- tofour-fold have an almost five-fold increased risk of developingbronchial asthma. There was also an increased severity of diseasemarkers in bronchial asthma patients who carry this MBL polymorphism.

An aspect of the invention thus provides a method for treating pulmonarydisorders, by administering a composition comprising a therapeuticallyeffective amount of a MASP-2 inhibitory agent in a pharmaceuticalcarrier to a subject suffering from pulmonary disorders, includingwithout limitation, acute respiratory distress syndrome,transfusion-related acute lung injury, ischemia/reperfusion acute lunginjury, chronic obstructive pulmonary disease, asthma, Wegener'sgranulomatosis, antiglomerular basement membrane disease (Goodpasture'sdisease), meconium aspiration syndrome, bronchiolitis obliteranssyndrome, idiopathic pulmonary fibrosis, acute lung injury secondary toburn, non-cardiogenic pulmonary edema, transfusion-related respiratorydepression, and emphysema. The MASP-2 inhibitory agent may beadministered to the subject systemically, such as by intra-arterial,intravenous, intramuscular, inhalational, nasal, subcutaneous or otherparenteral administration, or potentially by oral administration fornon-peptidergic agents. The MASP-2 inhibitory agent composition may becombined with one or more additional therapeutic agents, includinganti-inflammatory agents, antihistamines, corticosteroids orantimicrobial agents. Administration may be repeated as determined by aphysician until the condition has been resolved.

Extracorporeal Circulation

There are numerous medical procedures during which blood is divertedfrom a patient's circulatory system (extracorporeal circulation systemsor ECC). Such procedures include hemodialysis, plasmapheresis,leukopheresis, extracorporeal membrane oxygenator (ECMO),heparin-induced extracorporeal membrane oxygenation LDL precipitation(HELP) and cardiopulmonary bypass (CPB). These procedures expose bloodor blood products to foreign surfaces that may alter normal cellularfunction and hemostasis. In pioneering studies Craddock et al.identified complement activation as the probable cause ofgranulocytopenia during hemodialysis (Craddock, P. R., et al., N. Engl.J. Med. 296:769-74, 1977). The results of numerous studies between 1977and the present time indicate that many of the adverse eventsexperienced by patients undergoing hemodialysis or CPB are caused byactivation of the complement system (Chenoweth, D. E., Ann. N.Y. Acad.Sci. 5/6:306-313, 1987; Hugli, T. E., Complement 3:111-127, 1986;Cheung, A. K., J. Am. Soc. Nephrol. 1:150-161, 1990; Johnson, R. J.,Nephrol. Dial. Transplant 9:36-45 1994). For example, the complementactivating potential has been shown to be an important criterion indetermination of the biocompatibility of hemodialyzers with respect torecovery of renal function, susceptibility to infection, pulmonarydysfunction, morbidity, and survival rate of patients with renal failure(Hakim, R. M., Kidney Int. 44:484-4946, 1993).

It has been largely believed that complement activation by hemodialysismembranes occurs by alternative pathway mechanisms due to weak C4ageneration (Kirklin, J. K., et al., J. Thorac. Cardiovasc. Surg.86:845-57, 1983; Vallhonrat, H., et al., ASAIO 1 45:113-4, 1999), butrecent work suggests that the classical pathway may also be involved(Wachtfogel, Y. T., et al., Blood 73:468-471, 1989). However, there isstill inadequate understanding of the factors initiating and controllingcomplement activation on artificial surfaces including biomedicalpolymers. For example, Cuprophan membrane used in hemodialysis has beenclassified as a very potent complement activator. While not wishing tobe limited by theory, the inventors theorize that this could perhaps beexplained in part by its polysaccharide nature. The MASP-2-dependentcomplement activation system identified in this patent provides amechanism whereby activation of the lectin pathway triggers alternativepathway activation.

Patients undergoing ECC during CPB suffer a systemic inflammatoryreaction, which is partly caused by exposure of blood to the artificialsurfaces of the extracorporeal circuit, but also by surface-independentfactors like surgical trauma and ischemia-reperfusion injury (Butler,J., et al., Ann. Thorac. Surg. 55:552-9, 1993; Edmunds, L. H., Ann.Thorac. Surg. 66(Suppl):S12-6, 1998; Asimakopoulos, G., Perfusion14:269-77, 1999). The CPB-triggered inflammatory reaction can result inpostsurgical complications, generally termed “postperfusion syndrome.”Among these postoperative events are cognitive deficits (Fitch, J., etal., Circulation 100(25):2499-2506, 1999), respiratory failure, bleedingdisorders, renal dysfunction and, in the most severe cases, multipleorgan failure (Wan, S., et al., Chest 112:676-692, 1997). Coronarybypass surgery with CPB leads to profound activation of complement, incontrast to surgery without CPB but with a comparable degree of surgicaltrauma (E. Fosse, 1987). Therefore, the primary suspected cause of theseCPB-related problems is inappropriate activation of complement duringthe bypass procedure (Chenoweth, K., et al., N. Engl. I Med.304:497-503, 1981; Haslam, P., et al., Anaesthesia 25:22-26, 1980; J. K.Kirklin, et al., J. Thorac. Cardiovasc. Surg. 86:845-857, 1983; Moore,F. D., et al., Ann. Surg 208:95-103, 1988; Steinberg, J., et al., J.Thorac. Cardiovasc. Surg 106:1901-1918, 1993). In CPB circuits, thealternative complement pathway plays a predominant role in complementactivation, resulting from the interaction of blood with the artificialsurfaces of the CPB circuits (Kirklin, J. K., et al., J. Thorac.Cardiovasc. Surg. 86:845-57, 1983; Kirklin, J. K., et al., Ann. Thorac.Surg. 41:193-199, 1986; Vallhonrat H., et al., ASAIO J. 45:113-4, 1999).However, there is also evidence that the classical complement pathway isactivated during CPB (Wachtfogel, Y. T., et al., Blood 73:468-471,1989).

Primary inflammatory substances are generated after activation of thecomplement system, including anaphylatoxins C3a and C5a, the opsoninC3b, and the membrane attack complex C5b-9. C3a and C5a are potentstimulators of neutrophils, monocytes, and platelets

(Haeffner-Cavaillon, N., et al., J. Immunol. 139:794-9, 1987; Fletcher,M. P., et al., Am. J. Physiol. 265:H1750-61, 1993; Rinder, C. S., etal., J. Clin. Invest. 96:1564-72, 1995; Rinder, C. S., et al.,Circulation 100:553-8, 1999). Activation of these cells results inrelease of proinflammatory cytokines (IL-1, IL-6, IL-8, TNF alpha),oxidative free radicals and proteases (Schindler, R., et al., Blood76:1631-8, 1990; Cruickshank, A. M., et al., Clin Sci. (Lond) 79:161-5,1990; Kawamura, T., et al., Can. J. Anaesth. 40:1016-21, 1993;Steinberg, J. B., et al., J. Thorac. Cardiovasc. Surg. 106:1008-1, 1993;Finn, A., et al., J. Thorac. Cardiovasc. Surg. 105:234-41, 1993; Ashraf,S. S., et al., J. Cardiothorac. Vasc. Anesth. 11:718-22, 1997). C5a hasbeen shown to upregulate adhesion molecules CD11b and CD18 of Mac-1 inpolymorphonuclear cells (PMNs) and to induce degranulation of PMNs torelease proinflammatory enzymes. Rinder, C., et al., CardiovascPharmacol. 27(Suppl 1):56-12, 1996; Evangelista, V., et al., Blood93:876-85, 1999; Kinkade, J. M., Jr., et al., Biochem. Biophys. Res.Commun. 114:296-303, 1983; Lamb, N. J., et al., Crit. Care Med.27:1738-44, 1999; Fujie, K., et al., Eur. J. Pharmacol. 374:117-25,1999. C5b-9 induces the expression of adhesion molecule P-selectin(CD62P) on platelets (Rinder, C. S., et al., J. Thorac. Cardiovasc.Surg. 118:460-6, 1999), whereas both C5a and C5b-9 induce surfaceexpression of P-selectin on endothelial cells (Foreman, K. E., et al.,J. Clin. Invest. 94:1147-55, 1994). These adhesion molecules areinvolved in the interaction among leukocytes, platelets and endothelialcells. The expression of adhesion molecules on activated endothelialcells is responsible for sequestration of activated leukocytes, whichthen mediate tissue inflammation and injury (Evangelista, V., Blood1999; Foreman, K. E., J. Clin. Invest. 1994; Lentsch, A. B., et al., J.Pathol. 190:343-8, 2000). It is the actions of these complementactivation products on neutrophils, monocytes, platelets and othercirculatory cells that likely lead to the various problems that ariseafter CPB.

Several complement inhibitors are being studied for potentialapplications in CPB. They include a recombinant soluble complementreceptor 1 (sCR1) (Chai, P. J., et al., Circulation 101:541-6, 2000), ahumanized single chain anti-C5 antibody (h5G1.1-scFv or Pexelizumab)(Fitch, J. C K., et al., Circulation 100:3499-506, 1999), a recombinantfusion hybrid (CAB-2) of human membrane cofactor protein and human decayaccelerating factor (Rinder, C. S., et al., Circulation 100:553-8,1999), a 13-residue C3-binding cyclic peptide (Compstatin) (Nilsson, B.,et al., Blood 92:1661-7, 1998) and an anti-factor D MoAb (Fung, M., etal., J. Thoracic Cardiovasc. Surg. 122:113-22, 2001). SCR1 and CAB-2inhibit the classical and alternative complement pathways at the stepsof C3 and C5 activation. Compstatin inhibits both complement pathways atthe step of C3 activation, whereas h5G1.1-scFv does so only at the stepof C5 activation. Anti-factor D MoAb inhibits the alternative pathway atthe steps of C3 and C5 activation. However, none of these complementinhibitors would specifically inhibit the MASP-2-dependent complementactivation system identified in this patent.

Results from a large prospective phase 3 clinical study to investigatethe efficacy and safety of the humanized single chain anti-CS antibody(h5G1.1-scFv, pexelizu mab) in reducing perioperative MI and mortalityin coronary artery bypass graft (CABG) surgery has been reported(Verner, E. D., et al., JAMA 291:2319-27, 2004). Compared with placebo,pexelizu mab was not associated with a significant reduction in the riskof the composite end point of death or MI in 2746 patients who hadundergone CABG surgery. However, there was a statistically significantreduction 30 days after the procedure among all 3099 patients undergoingCABG surgery with or without valve surgery. Since pexelizu mab inhibitsat the step of C5 activation, it inhibits C5a and sC5b-9 generation buthas no effect on generation of the other two potent complementinflammatory substances, C3a and opsonic C3b, which are also known tocontribute to the CPB-triggered inflammatory reaction.

One aspect of the invention is thus directed to the prevention ortreatment of extracorporeal exposure-triggered inflammatory reaction bytreating a subject undergoing an extracorporeal circulation procedurewith a composition comprising a therapeutically effective amount of aMASP-2 inhibitory agent in a pharmaceutical carrier, including patientsundergoing hemodialysis, plasmapheresis, leukopheresis, extracorporealmembrane oxygenation (ECMO), heparin-induced extracorporeal membraneoxygenation LDL precipitation (HELP) and cardiopulmonary bypass (CPB).MASP-2 inhibitory agent treatment in accordance with the methods of thepresent invention is believed to be useful in reducing or preventing thecognitive dysfunction that sometimes results from CPB procedures. TheMASP-2 inhibitory agent may be administered to the subjectpreprocedurally and/or intraprocedurally and/or postprocedurally, suchas by intra-arterial, intravenous, intramuscular, subcutaneous or otherparenteral administration. Alternately, the MASP-2 inhibitory agent maybe introduced to the subject's bloodstream during extracorporealcirculation, such as by injecting the MASP-2 inhibitory agent intotubing or a membrane through or past which the blood is circulated or bycontacting the blood with a surface that has been coated with the MASP-2inhibitory agent such as an interior wall of the tubing, membrane orother surface such as a CPB device.

Inflammatory and Non-inflammatory Arthritides and Other MusculoskeletalDiseases

Activation of the complement system has been implicated in thepathogenesis of a wide variety of rheumatological diseases; includingrheumatoid arthritis (Linton, S. M., et al., Molec. Immunol. 36:905-14,1999), juvenile rheumatoid arthritis (Mollnes, T. E., et al., ArthritisRheum. 29:1359-64, 1986), osteoarthritis (Kemp, P. A., et al., J. Clin.Lab. Immunol. 37:147-62, 1992), systemic lupus erythematosis (SLE)(Molina, H., Current Opinion in Rheumatol. 14:492-497, 2002), Behcet'ssyndrome (Rumfeld, W. R., et al., Br. J. Rheumatol. 25:266-70, 1986) andSjogren's syndrome (Sanders, M. E., et al., J. Immunol. 138:2095-9,1987).

There is compelling evidence that immune-complex-triggered complementactivation is a major pathological mechanism that contributes to tissuedamage in rheumatoid arthritis (RA). There are numerous publicationsdocumenting that complement activation products are elevated in theplasma of RA patients (Morgan, B. P., et al., Clin. Exp. Immunol,73:473-478, 1988; Auda, G., et al., Rheumatol. Int. 10:185-189, 1990;Rumfeld, W. R., et al., Br. J. Rheumatol. 25:266-270, 1986). Complementactivation products such as C3a, C5a, and sC5b-9 have also been foundwithin inflamed rheumatic joints and positive correlations have beenestablished between the degree of complement activation and the severityof RA (Makinde, V. A., et al., Ann. Rheum. Dis. 48:302-306, 1989;Brodeur, J. P., et al., Arthritis Rheumatism 34:1531-1537, 1991). Inboth adult and juvenile rheumatoid arthritis, elevated serum andsynovial fluid levels of alternative pathway complement activationproduct Bb compared to C4d (a marker for classical pathway activation),indicate that complement activation is mediated predominantly by thealternative pathway (El-Ghobarey, A. F. et al., J. Rheumatology7:453-460, 1980; Agarwal, A., et al., Rheumatology 39:189-192, 2000).Complement activation products can directly damage tissue (via C5b-9) orindirectly mediate inflammation through recruitment of inflammatorycells by the anaphylatoxins C3a and C5a.

Animal models of experimental arthritis have been widely used toinvestigate the role of complement in the pathogenesis of RA. Complementdepletion by cobra venom factor in animal models of RA prevents theonset of arthritis (Morgan, K., et al., Arthritis Rheumat. 24:1356-1362,1981; Van Lent, P. L., et al., Am. J. Pathol. 140:1451-1461, 1992).Intra-articular injection of the soluble form of complement receptor 1(sCR1), a complement inhibitor, suppressed inflammation in a rat modelof RA (Goodfellow, R. M., et al., Clin. Exp. Immunol. 110:45-52, 1997).Furthermore, sCR1 inhibits the development and progression of ratcollagen-induced arthritis (Goodfellow, R. M., et al., Clin Exp.Immunol. 119:210-216, 2000). Soluble CR1 inhibits the classical andalternative complement pathways at the steps of C3 and C5 activation inboth the alternative pathway and the classical pathway, therebyinhibiting generation of C3a, C5a and sCSb-9.

In the late 1970s it was recognized that immunization of rodents withheterologous type II collagen (CII; the major collagen component ofhuman joint cartilage) led to the development of an autoimmune arthritis(collagen-induced arthritis, or CIA) with significant similarities tohuman RA (Courtenay, J. S., et al., Nature 283:666-68 (1980), Banda etal., J. of Immunol. 171:2109-2115 (2003)). The autoimmune response insusceptible animals involves a complex combination of factors includingspecific major histocompatability complex (MHC) molecules, cytokines andCII-specific B- and T-cell responses (reviewed by Myers, L. K., et al.,Life Sciences 61:1861-78, 1997). The observation that almost 40% ofinbred mouse strains have a complete deficiency in complement componentC5 (Cinader, B., et al., J. Exp. Med. 120:897-902, 1964) has provided anindirect opportunity to explore the role of complement in this arthriticmodel by comparing CIA between C5-deficient and sufficient strains.Results from such studies indicate that C5 sufficiency is an absoluterequirement for the development of CIA (Watson et al., 1987; Wang, Y.,et al., J. Immunol. 164:4340-4347, 2000). Further evidence of theimportance of C5 and complement in RA has been provided by the use ofanti-05 monoclonal antibodies (MoAbs). Prophylactic intraperitonealadministration of anti-CS MoAbs in a murine model of CIA almostcompletely prevented disease onset while treatment during activearthritis resulted in both significant clinical benefit and milderhistological disease (Wang, Y., et al., Proc. Natl. Acad. Sci. USA92:8955-59, 1995).

Additional insights about the potential role of complement activation indisease pathogenesis have been provided by studies using K/BxN T-cellreceptor transgenic mice, a recently developed model of inflammatoryarthritis (Korganow, A. S., et al., Immunity 10:451-461, 1999). AllK/BxN animals spontaneously develop an autoimmune disease with most(although not all) of the clinical, histological and immunologicalfeatures of RA in humans. Furthermore, transfer of serum from arthriticK/BxN mice into healthy animals provokes arthritis within days via thetransfer of arthritogenic immunoglobulins. To identify the specificcomplement activation steps required for disease development, serum fromarthritic K/BxN mice was transferred into various mice geneticallydeficient for a particular complement pathway product (Ji, H., et al.,Immunity 16:157-68, 2002). Interestingly, the results of the studydemonstrated that alternative pathway activation is critical, whereasclassical pathway activation is dispensable. In addition, the generationof C5a is critical since both CS-deficient mice and CSaR-deficient micewere protected from disease development. Consistent with these results,a previous study reported that genetic ablation of C5a receptorexpression protects mice from arthritis (Grant, E. P., et al., J. Exp.Med. 196:1461-1471, 2002).

A humanized anti-C5 MoAb (5G1.1) that prevents the cleavage of humancomplement component C5 into its pro-inflammatory components is underdevelopment by Alexion Pharmaceuticals, Inc., New Haven, Conn., as apotential treatment for RA.

Two research groups have independently proposed that the lectin pathwaypromotes inflammation in RA patients via interaction of MBL withspecific IgG glycoforms (Malhotra et al., Nat. Med. 1:237-243, 1995;Cuchacovich et al., J. Rheumatol. 23:44-51, 1996). RA is associated witha marked increase in IgG glycoforms that lack galactose (referred to asIgGO glycoforms) in the Fc region of the molecule (Rudd et al., TrendsBiotechnology 22:524-30, 2004). The percentage of IgGO glycoformsincreases with disease progression, and returns to normal when patientsgo into remission. In vivo, IgGO is deposited on synovial tissue and MBLis present at increased levels in synovial fluid in individuals with RA.Aggregated agalactosyl IgG (IgG0) on the clustered IgG associated withRA can bind mannose-binding lectin (MBL) and activate the lectin pathwayof complement. Furthermore, results from a recent clinical study lookingat allelic variants of MBL in RA patients suggest that MBL may have aninflammatory-enhancing role in the disease (Garred et al., J. Rheumatol.27:26-34, 2000). Therefore, the lectin pathway may have an importantrole in the pathogenesis of RA.

Systemic lupus erythematosus (SLE) is an autoimmune disease of undefinedetiology that results in production of autoantibodies, generation ofcirculating immune complexes, and episodic, uncontrolled activation ofthe complement system. Although the origins of autoimmunity in SLEremain elusive, considerable information is now available implicatingcomplement activation as an important mechanism contributing to vascularinjury in this disease (Abramson, S. B., et al., Hospital Practice33:107-122, 1998). Activation of both the classical and alternativepathways of complement are involved in the disease and both C4d and Bbare sensitive markers of moderate-to-severe lupus disease activity(Manzi, S., et al., Arthrit. Rheumat. 39:1178-1188, 1996). Activation ofthe alternative complement pathway accompanies disease flares insystemic lupus erythematosus during pregnancy (Buyon, J. P., et al.,Arthritis Rheum. 35:55-61, 1992). In addition, the lectin pathway maycontribute to disease development since autoantibodies against MBL haverecently been identified in sera from SLE patients (Seelen, M. A., etal., Clin Exp. Immunol. 134:335-343, 2003).

Immune complex-mediated activation of complement through the classicpathway is believed to be one mechanism by which tissue injury occurs inSLE patients. However, hereditary deficiencies in complement componentsof the classic pathway increase the risk of lupus and lupus-like disease(Pickering, M. C., et al., Adv. Immunol. 76:227-324, 2000). SLE, or arelated syndrome occurs in more than 80% of persons with completedeficiency of C1q, C1r/C1s, C4 or C3. This presents an apparent paradoxin reconciling the harmful effects with the protective effects ofcomplement in lupus.

An important activity of the classical pathway appears to be promotionof the removal of immune complexes from the circulation and tissues bythe mononuclear phagocytic system (Kohler, P. F., et al., Am. J. Med.56:406-11, 1974). In addition, complement has recently been found tohave an important role in the removal and disposal of apoptotic bodies(Mevorarch, D., et al., J. Exp. Med. 188:2313-2320, 1998). Deficiency inclassical pathway function may predispose subjects to the development ofSLE by allowing a cycle to develop in which immune complexes orapoptotic cells accumulate in tissues, cause inflammation and therelease of autoantigens, which in turn stimulate the production ofautoantibodies and more immune complexes and thereby evoke an autoimmuneresponse (Botto, M., et al., Nat. Genet. 19:56-59, 1998; Botto, M.,Arthritis Res. 3:201-10, 2001). However, these “complete” deficiencystates in classical pathway components are present in approximately oneof 100 patients with SLE. Therefore, in the vast majority of SLEpatients, complement deficiency in classical pathway components does notcontribute to the disease etiology and complement activation may be animportant mechanism contributing to SLE pathogenesis. The fact that rareindividuals with permanent genetic deficiencies in classical pathwaycomponents frequently develop SLE at some point in their lives testifiesto the redundancy of mechanisms capable of triggering the disease.

Results from animal models of SLE support the important role ofcomplement activation in pathogenesis of the disease. Inhibiting theactivation of C5 using a blocking anti-CS MoAb decreased proteinuria andrenal disease in NZB/NZW F 1 mice, a mouse model of SLE (Wang Y., etal., Proc. Natl. Acad. Sci. USA 93:8563-8, 1996). Furthermore, treatmentwith anti-C5 MoAb of mice with severe combined immunodeficiency diseaseimplanted with cells secreting anti-DNA antibodies results inimprovement in the proteinuria and renal histologic picture with anassociated benefit in survival compared to untreated controls(Ravirajan, C. T., et al., Rheumatology 43:442-7, 2004). The alternativepathway also has an important role in the autoimmune diseasemanifestations of SLE since backcrossing of factor B-deficient mice ontothe MRL/lpr model of SLE revealed that the lack of factor B lessened thevasculitis, glomerular disease, C3 consumption and IgG3 RF levelstypically found in this model without altering levels of otherautoantibodies (Watanabe, H., et al., J. Immunol. 164:786-794, 2000). Ahumanized anti-C5 MoAb is under investigation as a potential treatmentfor SLE. This antibody prevents the cleavage of C5 to C5a and C5b. InPhase I clinical trials, no serious adverse effects were noted, and morehuman trials are under way to determine the efficacy in SLE (Strand, V.,Lupus 10:216-221, 2001).

Results from both human and animal studies support the possibility thatthe complement system contributes directly to the pathogenesis ofmuscular dystrophy. Studies of human dystrophic biopsies have shown thatC3 and C9 are deposited on both necrotic and non-necrotic fibers indystrophic muscle (Cornelio and Dones, Ann. Neurol. 16:694-701, 1984;Spuler and Engel, A. G., Neurology 50:41-46, 1998). Using DNA microarraymethods, Porter and colleagues found markedly enhanced gene expressionof numerous complement-related mRNAs in dystrophin-deficient (mdv) micecoincident with development of the dystrophic disease (Porter et al.,Hum. Mol. Genet. 11:263-72, 2002). Mutations in the human gene encodingdysferlin, a transmembrane muscle protein, have been identified as majorrisk factors for two forms of skeletal muscle disease, namely limbgirdle muscular dystrophy (LGMD) and Miyoshi myopathy (Liu et al., Nat.Genet. 20:31-6, 1998). Several mouse model with mutations in dysferlinhave been developed and they also develop progressive musculardystrophy. Activation of the complement cascade has been identified onthe surface of nonnecrotic muscle fibers in some patients with LGMD(Spuler and Engel., Neurology 50:41-46, 1998). In a recent study, Wenzeland colleagues showed that both murine and human dysferlin-deficientmuscle fibers lack the complement inhibitory factor, CD33/DAF, aspecific inhibitor of C5b-9 MAC (membrane attack complex) (Wenzel etal., J. Immunol. 175:6219-25, 2005). As a consequence,dysferlin-deficient nonnecrotic muscle cells are more susceptible tocomplement-mediated cell lysis. Wenzel and colleagues suggest thatcomplement-mediated lysis of skeletal muscle cells may be a majorpathological mechanism involved in the development of LGMD and Miyoshimyopathy in patients. Connolly and colleagues studied the role ofcomplement C3 in the pathogenesis of a severe model of congenitaldystrophy, the dy−/− mouse, which is laminin a2-deficient (Connolly etal., J. Neuroimmunol. 127:80-7, 2002). They generated animalsgenetically deficient in both C3 and laminin a2 and found that theabsence of C3 prolonged survival in the dy−/− model of musculardystrophy. Furthermore, the double knockout (C3−/−, dy−/−) micedemonstrated more muscular strength than the dy−/− mice. This worksuggests that the complement system may contribute directly to thepathogenesis of this form of congenital dystrophy.

One aspect of the invention is thus directed to the prevention ortreatment of inflammatory and non-inflammatory arthritides and othermusculoskeletal disorders, including but not limited to osteoarthritis,rheumatoid arthritis, juvenile rheumatoid arthritis, gout, neuropathicarthropathy, psoriatic arthritis, ankylosing spondylitis or otherspondyloarthropathies and crystalline arthropathies, muscular dystrophyor systemic lupus erythematosus (SLE), by administering a compositioncomprising a therapeutically effective amount of a MASP-2 inhibitoryagent in a pharmaceutical carrier to a subject suffering from such adisorder. The MASP-2 inhibitory agent may be administered to the subjectsystemically, such as by intra-arterial, intravenous, intramuscular,subcutaneous or other parenteral administration, or potentially by oraladministration for non-peptidergic agents. Alternatively, administrationmay be by local delivery, such as by intra-articular injection. TheMASP-2 inhibitory agent may be administered periodically over anextended period of time for treatment or control of a chronic condition,or may be by single or repeated administration in the period before,during and/or following acute trauma or injury, including surgicalprocedures performed on the joint.

Renal Conditions

Activation of the complement system has been implicated in thepathogenesis of a wide variety of renal diseases; including,mesangioproliferative glomerulonephritis (IgA-nephropathy, Berger'sdisease) (Endo, M., et al., Clin. Nephrology 55:185-191, 2001),membranous glomerulonephritis (Kerjashki, D., Arch B Cell Pathol.58:253-71, 1990; Brenchley, P. E., et al., Kidney Int., 41:933-7, 1992;Salant, D. J., et al., Kidney Int. 35:976-84, 1989),membranoproliferative glomerulonephritis (mesangiocapillaryglomerulonephritis) (Bartlow, B. G., et al., Kidney Int. 15:294-300,1979; Meri, S., et al., J. Exp. Med. 175:939-50, 1992), acutepostinfectious glomerulonephritis (poststreptococcalglomerulonephritis), cryoglobulinemic glomerulonephritis (Ohsawa, I., etal., Clin Immunol. 101:59-66, 2001), lupus nephritis (Gatenby, P. A.,Autoimmunity 11:61-6, 1991), and Henoch-Schonlein purpura nephritis(Endo, M., et al., Am. J. Kidney Dis. 35:401-407, 2000). The involvementof complement in renal disease has been appreciated for several decadesbut there is still a major discussion on its exact role in the onset,the development and the resolution phase of renal disease. Under normalconditions the contribution of complement is beneficial to the host, butinappropriate activation and deposition of complement may contribute totissue damage.

There is substantial evidence that glomerulonephritis, inflammation ofthe glomeruli, is often initiated by deposition of immune complexes ontoglomerular or tubular structures which then triggers complementactivation, inflammation and tissue damage. Kahn and

Sinniah demonstrated increased deposition of C5b-9 in tubular basementmembranes in biopsies taken from patients with various forms ofglomerulonephritis (Kahn, T. N., et al., Histopath. 26:351-6, 1995). Ina study of patients with IgA nephrology (Alexopoulos, A., et al.,Nephrol. Dial. Transplant 10:1166-1172, 1995), C5b-9 deposition in thetubular epithelial/basement membrane structures correlated with plasmacreatinine levels. Another study of membranous nephropathy demonstrateda relationship between clinical outcome and urinary sC5b-9 levels (Kon,S. P., et al., Kidney Int. 48:1953-58, 1995). Elevated sC5b-9 levelswere correlated positively with poor prognosis. Lehto et al., measuredelevated levels of CD59, a complement regulatory factor that inhibitsthe membrane attack complex in plasma membranes, as well as C5b-9 inurine from patients with membranous glomerulonephritis (Lehto, T., etal., Kidney Int. 47:1403-11, 1995). Histopathological analysis of biopsysamples taken from these same patients demonstrated deposition of C3 andC9 proteins in the glomeruli, whereas expression of CD59 in thesetissues was diminished compared to that of normal kidney tissue. Thesevarious studies suggest that ongoing complement-mediatedglomerulonephritis results in urinary excretion of complement proteinsthat correlate with the degree of tissue damage and disease prognosis.

Inhibition of complement activation in various animal models ofglomerulonephritis has also demonstrated the importance of complementactivation in the etiology of the disease. In a model ofmembranoproliferative glomerulonephritis (MPGN), infusion of anti-Thy 1antiserum in C6-deficient rats (that cannot form C5b-9) resulted in 90%less glomerular cellular proliferation, 80% reduction in platelet andmacrophage infiltration, diminished collagen type IV synthesis (a markerfor mesangial matrix expansion), and 50% less proteinuria than inC6+normal rats (Brandt, J., et al., Kidney Int. 49:335-343, 1996). Theseresults implicate C5b-9 as a major mediator of tissue damage bycomplement in this rat anti-thymocyte serum model. In another model ofglomerulonephritis, infusion of graded dosages of rabbit anti-ratglomerular basement membrane produced a dose-dependent influx ofpolymorphonuclear leukocytes (PMN) that was attenuated by priortreatment with cobra venom factor (to consume complement) (Scandrett, A.L., et al., Am. J. Physiol. 268:F256-F265, 1995). Cobra venomfactor-treated rats also showed diminished histopathology, decreasedlong-term proteinuria, and lower creatinine levels than control rats.Employing three models of GN in rats (anti-thymocyte serum, Con Aanti-Con A, and passive Heymann nephritis), Couser et al., demonstratedthe potential therapeutic efficacy of approaches to inhibit complementby using the recombinant sCR1 protein (Couser, W. G., et al., J. Am.Soc. Nephrol. 5:1888-94, 1995). Rats treated with sCR1 showedsignificantly diminished PMN, platelet and macrophage influx, decreasedmesangiolysis, and proteinuria versus control rats. Further evidence forthe importance of complement activation in glomerulonephritis has beenprovided by the use of an anti-CS MoAb in the NZB/W F1 mouse model. Theanti-C5 MoAb inhibits cleavage of C5, thus blocking generation of C5aand C5b-9. Continuous therapy with anti-CS MoAb for 6 months resulted insignificant amelioration of the course of glomerulonephritis. Ahumanized anti-CS MoAb monoclonal antibody (5G1.1) that prevents thecleavage of human complement component C5 into its pro-inflammatorycomponents is under development by Alexion Pharmaceuticals, Inc., NewHaven, Conn., as a potential treatment for glomerulonephritis.

Direct evidence for a pathological role of complement in renal injury isprovided by studies of patients with genetic deficiencies in specificcomplement components. A number of reports have documented anassociation of renal disease with deficiencies of complement regulatoryfactor H (Ault, B. H., Nephrol. 14:1045-1053, 2000; Levy, M., et al.,Kidney Int. 30:949-56, 1986; Pickering, M. C., et al., Nat. Genet.31:424-8, 2002). Factor H deficiency results in low plasma levels offactor B and C3 and in consumption of C5b-9. Both atypicalmembranoproliferative glomerulonephritis (MPGN) and idiopathic hemolyticuremic syndrome (HUS) are associated with factor H deficiency. Factor Hdeficient pigs (Jansen, J. H., et al., Kidney Int. 53:331-49, 1998) andfactor H knockout mice (Pickering, M. C., 2002) display MPGN-likesymptoms, confirming the importance of factor H in complementregulation. Deficiencies of other complement components are associatedwith renal disease, secondary to the development of systemic lupuserythematosus (SLE) (Walport, M. J., Davies, et al., Ann. N.Y. Acad.Sci. 8/5:267-81, 1997). Deficiency for C1q, C4 and C2 predisposestrongly to the development of SLE via mechanisms relating to defectiveclearance of immune complexes and apoptotic material. In many of theseSLE patients lupus nephritis occurs, characterized by the deposition ofimmune complexes throughout the glomerulus.

Further evidence linking complement activation and renal disease hasbeen provided by the identification in patients of autoantibodiesdirected against complement components, some of which have been directlyrelated to renal disease (Trouw, L. A., et al., Mol. Immunol.38:199-206, 2001). A number of these autoantibodies show such a highdegree of correlation with renal disease that the term nephritic factor(NeF) was introduced to indicate this activity. In clinical studies,about 50% of the patients positive for nephritic factors developed MPGN(Spitzer, R. E., et al., Clin. Immunol. Immunopathol. 64:177-83, 1992).C3NeF is an autoantibody directed against the alternative pathway C3convertase (C3bBb) and it stabilizes this convertase, thereby promotingalternative pathway activation (Daha, M.R., et al., J. Immunol. 116:1-7,1976). Likewise, autoantibody with a specificity for the classicalpathway C3 convertase (C4b2a), called C4NeF, stabilizes this convertaseand thereby promotes classical pathway activation (Daha, M.R. et al., J.Immunol. 125:2051-2054, 1980; Halbwachs, L., et al., J. Clin. Invest.65:1249-56, 1980). Anti-C1q autoantibodies have been described to berelated to nephritis in SLE patients (Hovath, L., et al., Clin. Exp.Rheumatol. 19:667-72, 2001; Siegert, C., et al., J. Rheumatol.18:230-34, 1991; Siegert, C., et al., Clin. Exp. Rheumatol. 10:19-23,1992), and a rise in the titer of these anti-C1q autoantibodies wasreported to predict a flare of nephritis (Coremans, I. E., et al., Am.J. Kidney Dis. 26:595-601, 1995). Immune deposits eluted from postmortemkidneys of SLE patients revealed the accumulation of these anti-C1qautoantibodies (Mannick, M., et al., Arthritis Rheumatol. 40:1504-11,1997). All these facts point to a pathological role for theseautoantibodies. However, not all patients with anti-C1q autoantibodiesdevelop renal disease and also some healthy individuals have low titeranti-C1q autoantibodies (Siegert, C. E., et al., Clin. Immunol.Immunopathol. 67:204-9, 1993).

In addition to the alternative and classical pathways of complementactivation, the lectin pathway may also have an important pathologicalrole in renal disease. Elevated levels of MBL, MBL-associated serineprotease and complement activation products have been detected byimmunohistochemical techniques on renal biopsy material obtained frompatients diagnosed with several different renal diseases, includingHenoch-Schonlein purpura nephritis (Endo, M., et al., Am. J. Kidney Dis.35:401-407, 2000), cryoglobulinemic glomerulonephritis (Ohsawa, I., etal., Clin. Immunol. 101:59-66, 2001) and IgA neuropathy (Endo, M., etal., Clin. Nephrology 55:185-191, 2001). Therefore, despite the factthat an association between complement and renal diseases has been knownfor several decades, data on how complement exactly influences theserenal diseases is far from complete.

One aspect of the invention is thus directed to the treatment of renalconditions including but not limited to mesangioproliferativeglomerulonephritis, membranous glomerulonephritis, membranoproliferativeglomerulonephritis (mesangiocapillary glomerulonephritis), acutepostinfectious glomerulonephritis (poststreptococcalglomerulonephritis), cryoglobulinemic glomerulonephritis, lupusnephritis, Henoch-Schonlein purpura nephritis or IgA nephropathy, byadministering a composition comprising a therapeutically effectiveamount of a MASP-2 inhibitory agent in a pharmaceutical carrier to asubject suffering from such a disorder. The MASP-2 inhibitory agent maybe administered to the subject systemically, such as by intra-arterial,intravenous, intramuscular, subcutaneous or other parenteraladministration, or potentially by oral administration fornon-peptidergic agents. The MASP-2 inhibitory agent may be administeredperiodically over an extended period of time for treatment or control ofa chronic condition, or may be by single or repeated administration inthe period before, during or following acute trauma or injury.

Skin Disorders

Psoriasis is a chronic, debilitating skin condition that affectsmillions of people and is attributed to both genetic and environmentalfactors. Topical agents as well as UVB and PUVA phototherapy aregenerally considered to be the first-line treatment for psoriasis.However, for generalized or more extensive disease, systemic therapy isindicated as a primary treatment or, in some cases, to potentiate UVBand PUVA therapy.

The underlying etiology of various skins diseases such as psoriasissupport a role for immune and proinflammatory processes including theinvolvement of the complement system. Moreover, the role of thecomplement system has been established as an important nonspecific skindefense mechanism. Its activation leads to the generation of productsthat not only help to maintain normal host defenses, but also mediateinflammation and tissue injury. Proinflammatory products of complementinclude large fragments of C3 with opsonic and cell-stimulatoryactivities (C3b and C3bi), low molecular weight anaphylatoxins (C3a,C4a, and C5a), and membrane attack complexes. Among them, C5a or itsdegradation product C5a des Arg, seems to be the most important mediatorbecause it exerts a potent chemotactic effect on inflammatory cells.Intradermal administration of C5a anaphylatoxin induces skin changesquite similar to those observed in cutaneous hypersensitivity vasculitisthat occurs through immune complex-mediated complement activation.Complement activation is involved in the pathogenesis of theinflammatory changes in autoimmune bullous dermatoses. Complementactivation by pemphigus antibody in the epidermis seems to beresponsible for the development of characteristic inflammatory changestermed eosinophilic spongiosis. In bullous pemphigoid (BP), interactionof basement membrane zone antigen and BP antibody leads to complementactivation that seems to be related to leukocytes lining thedermoepidermal junction. Resultant anaphylatoxins not only activate theinfiltrating leukocytes but also induce mast cell degranulation, whichfacilitates dermoepidermal separation and eosinophil infiltration.Similarly, complement activation seems to play a more direct role in thedermoepidermal separation noted in epidermolysis bullosa acquisita andherpes gestationis.

Evidence for the involvement of complement in psoriasis comes fromrecent experimental findings described in the literature related to thepathophysiological mechanisms for the inflammatory changes in psoriasisand related diseases. A growing body of evidence has indicated thatT-cell-mediated immunity plays an important role in the triggering andmaintenance of psoriatic lesions. It has been revealed that lymphokinesproduced by activated T-cells in psoriatic lesions have a stronginfluence on the proliferation of the epidermis. Characteristicneutrophil accumulation under the stratum corneum can be observed in thehighly inflamed areas of psoriatic lesions. Neutrophils arechemotactically attracted and activated there by synergistic action ofchemokines, IL-8 and Gro-alpha released by stimulated keratinocytes, andparticularly by C5a/C5a des-arg produced via the alternative complementpathway activation (Terui, T., Tahoku J. Exp. Med. 190:239-248, 2000;Terui, T., Exp. Dermatol. 9:1-10, 2000).

Psoriatic scale extracts contain a unique chemotactic peptide fractionthat is likely to be involved in the induction of rhythmictransepidermal leukocyte chemotaxis. Recent studies have identified thepresence of two unrelated chemotactic peptides in this fraction, i.e.,C5a/C5a des Arg and interleukin 8 (IL-8) and its related cytokines. Toinvestigate their relative contribution to the transepidermal leukocytemigration as well as their interrelationship in psoriatic lesions,concentrations of immunoreactive C5a/C5a desArg and IL-8 in psoriaticlesional scale extracts and those from related sterile pustulardermatoses were quantified. It was found that the concentrations ofC5a/C5a desArg and IL-8 were more significantly increased in thehorny-tissue extracts from lesional skin than in those fromnon-inflammatory orthokeratotic skin. The increase of C5a/C5a desArgconcentration was specific to the lesional scale extracts. Based onthese results, it appears that C5a/C5a desArg is generated only in theinflammatory lesional skin under specific circumstances thatpreferentially favor complement activation. This provides a rationalefor the use of an inhibitor of complement activation to amelioratepsoriatic lesions.

While the classical pathway of the complement system has been shown tobe activated in psoriasis, there are fewer reports on the involvement ofthe alternative pathway in the inflammatory reactions in psoriasis.Within the conventional view of complement activation pathways,complement fragments C4d and Bb are released at the time of theclassical and alternative pathway activation, respectively. The presenceof the C4d or Bb fragment, therefore, denotes a complement activationthat proceeds through the classical and/or alternative pathway. Onestudy measured the levels of C4d and Bb in psoriatic scale extractsusing enzyme immunoassay techniques. The scales of these dermatosescontained higher levels of C4d and Bb detectable by enzyme immunoassaythan those in the stratum corneum of noninflammatory skin (Takematsu,H., et al., Dermatologica 181:289-292, 1990). These results suggest thatthe alternative pathway is activated in addition to the classicalpathway of complement in psoriatic lesional skin.

Additional evidence for the involvement of complement in psoriasis andatopic dermatitis has been obtained by measuring normal complementcomponents and activation products in the peripheral blood of 35patients with atopic dermatitis (AD) and 24 patients with psoriasis at amild to intermediate stage. Levels of C3, C4 and C1 inactivator (C1 INA)were determined in serum by radial immunodiffusion, whereas C3a and C5alevels were measured by radioimmunoassay. In comparison to healthynon-atopic controls, the levels of C3, C4 and Cl INA were found to besignificantly increased in both diseases. In AD, there was a tendencytowards increased C3a levels, whereas in psoriasis, C3a levels weresignificantly increased. The results indicate that, in both AD andpsoriasis, the complement system participates in the inflammatoryprocess (Ohkonohchi, K., et al., Dermatologica 179:30-34, 1989).

Complement activation in psoriatic lesional skin also results in thedeposition of terminal complement complexes within the epidermis asdefined by measuring levels of

SC5b-9 in the plasma and horny tissues of psoriatic patients. The levelsof SC5b-9 in psoriatic plasma have been found to be significantly higherthan those of controls or those of patients with atopic dermatitis.Studies of total protein extracts from lesional skin have shown that,while no SC5b-9 can be detected in the noninflammatory horny tissues,there were high levels of SC5b-9 in lesional horny tissues of psoriasis.By immunofluorescence using a monoclonal antibody to the C5b-9neoantigen, deposition of C5b-9 has been observed only in the stratumcorneum of psoriatic skin. In summary, in psoriatic lesional skin, thecomplement system is activated and complement activation proceeds allthe way to the terminal step, generating membrane attack complex. Newbiologic drugs that selectively target the immune system have recentlybecome available for treating psoriasis. Four biologic drugs that areeither currently FDA approved or in Phase 3 studies are: alefacept(Amevive®) and efalizuMoAb (Raptiva®) which are T-cell modulators;etanercept (Enbrel®), a soluble TNF-receptor; and inflixiMoAb(Remicade®), an anti-TNF monoclonal antibody. Raptiva is an immuneresponse modifier, wherein the targeted mechanism of action is ablockade of the interaction between LFA-1 on lymphocytes and ICAM-1 onantigen-presenting cells and on vascular endothelial cells. Binding ofCD11a by Raptiva results in saturation of available CD11a binding siteson lymphocytes and down-modulation of cell surface CD11a expression onlymphocytes. This mechanism of action inhibits T-cell activation, celltrafficking to the dermis and epidermis and T-cell reactivation. Thus, aplurality of scientific evidence indicates a role for complement ininflammatory disease states of the skin and recent pharmaceuticalapproaches have targeted the immune system or specific inflammatoryprocesses. None, however, have identified MASP-2 as a targeted approach.Based on the inventors' new understanding of the role of MASP-2 incomplement activation, the inventors believe MASP-2 to be an effectivetarget for the treatment of psoriasis and other skin disorders.

One aspect of the invention is thus directed to the treatment ofpsoriasis, autoimmune bullous dermatoses, eosinophilic spongiosis,bullous pemphigoid, epidermolysis bullosa acquisita, atopic dermatitis,herpes gestationis and other skin disorders, and for the treatment ofthermal and chemical burns including capillary leakage caused thereby,by administering a composition comprising a therapeutically effectiveamount of a MASP-2 inhibitory agent in a pharmaceutical carrier to asubject suffering from such a skin disorder. The MASP-2 inhibitory agentmay be administered to the subject topically, by application of a spray,lotion, gel, paste, salve or irrigation solution containing the MASP-2inhibitory agent, or systemically such as by intra-arterial,intravenous, intramuscular, subcutaneous or other parenteraladministration, or potentially by oral administration fornon-peptidergic inhibitors. Treatment may involve a singleadministration or repeated applications or dosings for an acutecondition, or by periodic applications or dosings for control of achronic condition.

Transplantation

Activation of the complement system significantly contributes to theinflammatory reaction after solid organ transplantation. Inallotransplantation, the complement system may be activated byischemia/reperfusion and, possibly, by antibodies directed against thegraft (Baldwin, W. M., et al., Springer Seminol Immunopathol.25:181-197, 2003). In xenotransplantation from nonprimates to primates,the major activators for complement are preexisting antibodies. Studiesin animal models have shown that the use of complement inhibitors maysignificantly prolong graft survival (see below). Thus, there is anestablished role of the complement system in organ injury after organtransplantation, and therefore the inventors believe that the use ofcomplement inhibitors directed to MASP-2 may prevent damage to the graftafter allo- or xenotransplantation.

Innate immune mechanisms, particularly complement, play a greater rolein inflammatory and immune responses against the graft than has beenpreviously recognized. For example, alternative complement pathwayactivation appears to mediate renal ischemia/reperfusion injury, andproximal tubular cells may be both the source and the site of attack ofcomplement components in this setting. Locally produced complement inthe kidney also plays a role in the development of both cellular andantibody-mediated immune responses against the graft.

C4d is the degradation product of the activated complement factor C4, acomponent of the classical and lectin-dependent pathways. C4d staininghas emerged as a useful marker of humoral rejection both in the acuteand in the chronic setting and led to renewed interest in thesignificance of anti-donor antibody formation. The association betweenC4d and morphological signs of acute cellular rejection is statisticallysignificant. C4d is found in 24-43% of Type I episodes, in 45% of typeII rejection and 50% of type III rejection (Nickeleit, V., et al., J.Am. Soc. Nephrol. 13:242-251, 2002; Nickeleit, V., et al., Nephrol.Dial. Transplant 18:2232-2239, 2003). A number of therapies are indevelopment that inhibit complement or reduce local synthesis as a meansto achieve an improved clinical outcome following transplantation.

Activation of the complement cascade occurs as a result of a number ofprocesses during transplantation. Present therapy, although effective inlimiting cellular rejection, does not fully deal with all the barriersfaced. These include humoral rejection and chronic allograft nephropathyor dysfunction. Although the overall response to the transplanted organis a result of a number of effector mechanisms on the part of the host,complement may play a key role in some of these. In the setting of renaltransplantation, local synthesis of complement by proximal tubular cellsappears of particular importance.

The availability of specific inhibitors of complement may provide theopportunity for an improved clinical outcome following organtransplantation. Inhibitors that act by a mechanism that blockscomplement attack may be particularly useful, because they hold thepromise of increased efficacy and avoidance of systemic complementdepletion in an already immuno-compromised recipient. Complement alsoplays a critical role in xenograft rejection. Therefore, effectivecomplement inhibitors are of great interest as potential therapeuticagents. In pig-to-primate organ transplantation, hyperacute rejection(HAR) results from antibody deposition and complement activation.Multiple strategies and targets have been tested to prevent hyperacutexenograft rejection in the pig-to-primate combination. These approacheshave been accomplished by removal of natural antibodies, complementdepletion with cobra venom factor, or prevention of C3 activation withthe soluble complement inhibitor sCR1. In addition, complementactivation blocker-2 (CAB-2), a recombinant soluble chimeric proteinderived from human decay accelerating factor (DAF) and membrane cofactorprotein, inhibits C3 and C5 convertases of both classical andalternative pathways. CAB-2 reduces complement-mediated tissue injury ofa pig heart perfused ex vivo with human blood. A study of the efficacyof CAB-2 when a pig heart was transplanted heterotopically into rhesusmonkeys receiving no immunosuppression showed that graft survival wasmarkedly prolonged in monkeys that received CAB-2 (Salerno, C. T., etal., Xenotransplantation 9:125-134, 2002). CAB-2 markedly inhibitedcomplement activation, as shown by a strong reduction in generation ofC3a and SC5b-9. At graft rejection, tissue deposition of iC3b, C4 and C9was similar or slightly reduced from controls, and deposition of IgG,IgM, C1q and fibrin did not change. Thus, this approach for complementinhibition abrogated hyperacute rejection of pig hearts transplantedinto rhesus monkeys. These studies demonstrate the beneficial effects ofcomplement inhibition on survival and the inventors believe that MASP-2inhibition may also be useful in xenotransplantation.

Another approach has focused on determining if anti-complement 5 (C5)monoclonal antibodies could prevent hyperacute rejection (HAR) in arat-to-presensitized mouse heart transplantation model and whether theseMoAb, combined with cyclosporine and cyclophosphamide, could achievelong-term graft survival. It was found that anti-05 MoAb prevents HAR(Wang, H., et al., Transplantation 68:1643-1651, 1999). The inventorsthus believe that other targets in the complement cascade, such asMASP-2, may also be valuable for preventing HAR and acute vascularrejection in future clinical xenotransplantation.

While the pivotal role of complement in hyperacute rejection seen inxenografts is well established, a subtler role in allogeneictransplantation is emerging. A link between complement and the acquiredimmune response has long been known, with the finding thatcomplement-depleted animals mounted subnormal antibody responsesfollowing antigenic stimulation. Opsonization of antigen with thecomplement split product C3d has been shown to greatly increase theeffectiveness of antigen presentation to B cells, and has been shown toact via engagement of complement receptor type 2 on certain B cells.This work has been extended to the transplantation setting in a skingraft model in mice, where C3- and C4-deficient mice had a marked defectin allo-antibody production, due to failure of class switching tohigh-affinity IgG. The importance of these mechanisms in renaltransplantation is increased due to the significance of anti-donorantibodies and humoral rejection.

Previous work has already demonstrated upregulation of C3 synthesis byproximal tubular cells during allograft rejection following renaltransplantation. The role of locally synthesized complement has beenexamined in a mouse renal transplantation model. Grafts from C3-negativedonors transplanted into C3-sufficient recipients demonstrated prolongedsurvival (>100 days) as compared with control grafts from C3-positivedonors, which were rejected within 14 days. Furthermore, the anti-donorT-cell proliferative response in recipients of C3-negative grafts wasmarkedly reduced as compared with that of controls, indicating an effectof locally synthesized C3 on T-cell priming.

These observations suggest the possibility that exposure of donorantigen to T-cells first occurs in the graft and that locallysynthesized complement enhances antigen presentation, either byopsonization of donor antigen or by providing additional signals to bothantigen-presenting cells and T-cells. In the setting of renaltransplantation, tubular cells that produce complement also demonstratecomplement deposition on their cell surface.

One aspect of the invention is thus directed to the prevention ortreatment of inflammatory reaction resulting from tissue or solid organtransplantation by administering a composition comprising atherapeutically effective amount of a MASP-2 inhibitory agent in apharmaceutical carrier to the transplant recipient, including subjectsthat have received allotransplantation or xenotransplantation of wholeorgans (e.g., kidney, heart, liver, pancreas, lung, cornea, etc.) orgrafts (e.g., valves, tendons, bone marrow, etc.). The MASP-2 inhibitoryagent may be administered to the subject by intra-arterial, intravenous,intramuscular, subcutaneous or other parenteral administration, orpotentially by oral administration for non-peptidergic inhibitors.Administration may occur during the acute period followingtransplantation and/or as long-term posttransplantation therapy.Additionally or in lieu of posttransplant administration, the subjectmay be treated with the MASP-2 inhibitory agent prior to transplantationand/or during the transplant procedure, and/or by pretreating the organor tissue to be transplanted with the MASP-2 inhibitory agent.Pretreatment of the organ or tissue may entail applying a solution, gelor paste containing the MASP-2 inhibitory agent to the surface of theorgan or tissue by spraying or irrigating the surface, or the organ ortissue may be soaked in a solution containing the MASP-2 inhibitor.

Central and Peripheral Nervous System Disorders and Injuries

Activation of the complement system has been implicated in thepathogenesis of a variety of central nervous system (CNS) or peripheralnervous system (PNS) diseases or injuries, including but not limited tomultiple sclerosis (MS), myasthenia gravis (MG), Huntington's disease(HD), amyotrophic lateral sclerosis (ALS), Guillain Barre syndrome,reperfusion following stroke, degenerative discs, cerebral trauma,Parkinson's disease (PD) and Alzheimer's disease (AD). The initialdetermination that complement proteins are synthesized in CNS cellsincluding neurons, astrocytes and microglia, as well as the realizationthat anaphylatoxins generated in the CNS following complement activationcan alter neuronal function, has opened up the potential role ofcomplement in CNS disorders (Morgan, B. P., et al., Immunology Today17(10):461-466, 1996). It has now been shown that C3a receptors and C5areceptors are found on neurons and show widespread distribution indistinct portions of the sensory, motor and limbic brain systems (Barum,S. R., Immunologic Research 26:7-13, 2002). Moreover, the anaphylatoxinsC5a and C3a have been shown to alter eating and drinking behavior inrodents and can induce calcium signaling in microglia and neurons. Thesefindings raise possibilities regarding the therapeutic utility ofinhibiting complement activation in a variety of CNS inflammatorydiseases including cerebral trauma, demyelination, meningitis, strokeand Alzheimer's disease.

Brain trauma or hemorrhage is a common clinical problem, and complementactivation may occur and exacerbate resulting inflammation and edema.The effects of complement inhibition have been studied in a model ofbrain trauma in rats (Kaczorowski et al., J. Cereb. Blood Flow Metab.15:860-864, 1995). Administration of sCR1 immediately prior to braininjury markedly inhibited neutrophil infiltration into the injured area,indicating complement was important for recruitment of phagocytic cells.Likewise, complement activation in patients following cerebralhemorrhage is clearly implicated by the presence of high levels ofmultiple complement activation products in both plasma and cerebrospinalfluid (CSF). Complement activation and increased staining of C5b-9complexes have been demonstrated in sequestered lumbar disc tissue andcould suggest a role in disc herniation tissue-induced sciatica(Gronblad, M., et al., Spine 28(2):114-118, 2003).

MS is characterized by a progressive loss of myelin ensheathing andinsulating axons within the CNS. Although the initial cause is unknown,there is abundant evidence implicating the immune system (Prineas, J.W., et al., Lab Invest. 38:409-421, 1978; Ryberg, B., J. Neurol. Sci.54:239-261, 1982). There is also clear evidence that complement plays aprominent role in the pathophysiology of CNS or PNS demyelinatingdiseases including MS, Guillain-Barre syndrome and Miller-Fishersyndrome (Gasque, P., et al., Immunopharmacology 49:171-186, 2000;Barnum, S. R. in Bondy S. et al. (eds.) Inflammatory events inneurodegeneration, Prominent Press, pp. 139-156, 2001). Complementcontributes to tissue destruction, inflammation, clearance of myelindebris and even remyelination of axons. Despite clear evidence ofcomplement involvement, the identification of complement therapeutictargets is only now being evaluated in experimental allergicencephalomyelitis (EAE), an animal model of multiple sclerosis. Studieshave established that EAE mice deficient in C3 or factor B showedattenuated demyelination as compared to EAE control mice (Barnum,Immunologic Research 26:7-13, 2002). EAE mouse studies using a solubleform of a complement inhibitor coined “sCrry” and C3−/− and factor B−/−demonstrated that complement contributes to the development andprogression of the disease model at several levels. In addition, themarked reduction in EAE severity in factor B−/− mice provides furtherevidence for the role of the alternative pathway of complement in EAE(Nataf et al., J. Immunology 165:5867-5873, 2000).

MG is a disease of the neuromuscular junction with a loss ofacetylcholine receptors and destruction of the end plate. sCR1 is veryeffective in an animal model of MG, further indicating the role ofcomplement in the disease (Piddelesden et al., J. Neuroimmunol. 1997).

The histological hallmarks of AD, a neurodegenerative disease, aresenile plaques and neurofibrillary tangles (McGeer et al., Res. Immunol.143:621-630, 1992). These pathological markers also stain strongly forcomponents of the complement system. Evidence points to a localneuroinflammatory state that results in neuronal death and cognitivedysfunction. Senile plaques contain abnormal amyloid-β□ peptide (Aβ□, apeptide derived from amyloid precursor protein. Aβ has been shown tobind C1 and can trigger complement activation (Rogers et al., Res.Immunol. 143:624-630, 1992). In addition, a prominent feature of AD isthe association of activated proteins of the classical complementpathway from C1q to C5b-9, which have been found highly localized in theneuritic plaques (Shen, Y., et al., Brain Research 769:391-395, 1997;Shen, Y., et al., Neurosci. Letters 305(3):165-168, 2001). Thus, Aβ notonly initiates the classical pathway, but a resulting continualinflammatory state may contribute to the neuronal cell death. Moreover,the fact that complement activation in AD has progressed to the terminalC5b-9 phase indicates that the regulatory mechanisms of the complementsystem have been unable to halt the complement activation process.

Several inhibitors of the complement pathway have been proposed aspotential therapeutic approaches for AD, including proteoglycan asinhibitors of C1Q binding, Nafamstat as an inhibitor of C3 convertase,and C5 activation blockers or inhibitors of C5a receptors (Shen, Y., etal., Progress in Neurobiology 70:463-472, 2003). The role of MASP-2 asan initiation step in the innate complement pathway, as well as foralternative pathway activation, provides a potential new therapeuticapproach and is supported by the wealth of data suggesting complementpathway involvement in AD.

In damaged regions in the brains of PD patients, as in other CNSdegenerative diseases, there is evidence of inflammation characterizedby glial reaction (especially microglia), as well as increasedexpression of HLA-DR antigens, cytokines, and components of complement.These observations suggest that immune system mechanisms are involved inthe pathogenesis of neuronal damage in PD. The cellular mechanisms ofprimary injury in PD have not been clarified, however, but it is likelythat mitochondrial mutations, oxidative stress and apoptosis play arole. Furthermore, inflammation initiated by neuronal damage in thestriatum and the substantial nigra in PD may aggravate the course of thedisease. These observations suggest that treatment with complementinhibitory drugs may act to slow progression of PD (Czlonkowska, A., etal., Med. Sci. Monit. 8:165-177, 2002).

One aspect of the invention is thus directed to the treatment ofperipheral nervous system (PNS) and/or central nervous system (CNS)disorders or injuries by treating a subject suffering from such adisorder or injury with a composition comprising a therapeuticallyeffective amount of a MASP-2 inhibitory agent in a pharmaceuticalcarrier. CNS and PNS disorders and injuries that may be treated inaccordance with the present invention are believed to include but arenot limited to multiple sclerosis (MS), myasthenia gravis (MG),Huntington's disease (HD), amyotrophic lateral sclerosis (ALS), GuillainBarre syndrome, reperfusion following stroke, degenerative discs,cerebral trauma, Parkinson's disease (PD), Alzheimer's disease (AD),Miller-Fisher syndrome, cerebral trauma and/or hemorrhage, demyelinationand, possibly, meningitis.

For treatment of CNS conditions and cerebral trauma, the MASP-2inhibitory agent may be administered to the subject by intrathecal,intracranial, intraventricular, intra-arterial, intravenous,intramuscular, subcutaneous, or other parenteral administration, andpotentially orally for non-peptidergic inhibitors. PNS conditions andcerebral trauma may be treated by a systemic route of administration oralternately by local administration to the site of dysfunction ortrauma. Administration of the MASP-2 inhibitory compositions of thepresent invention may be repeated periodically as determined by aphysician until effective relief or control of the symptoms is achieved.

Blood Disorders

Sepsis is caused by an overwhelming reaction of the patient to invadingmicroorganisms. A major function of the complement system is toorchestrate the inflammatory response to invading bacteria and otherpathogens. Consistent with this physiological role, complementactivation has been shown in numerous studies to have a major role inthe pathogenesis of sepsis (Bone, R. C., Annals. Internal. Med.115:457-469, 1991). The definition of the clinical manifestations ofsepsis is ever evolving. Sepsis is usually defined as the systemic hostresponse to an infection. However, on many occasions, no clinicalevidence for infection (e.g., positive bacterial blood cultures) isfound in patients with septic symptoms. This discrepancy was first takeninto account at a Consensus Conference in 1992 when the term “systemicinflammatory response syndrome” (SIRS) was established, and for which nodefinable presence of bacterial infection was required (Bone, R. C., etal., Crit. Care Med. 20:724-726, 1992). There is now general agreementthat sepsis and SIRS are accompanied by the inability to regulate theinflammatory response. For the purposes of this brief review, we willconsider the clinical definition of sepsis to also include severesepsis, septic shock, and SIRS.

The predominant source of infection in septic patients before the late1980s was Gram-negative bacteria. Lipopolysaccharide (LPS), the maincomponent of the Gram-negative bacterial cell wall, was known tostimulate release of inflammatory mediators from various cell types andinduce acute infectious symptoms when injected into animals (Haeney, M.R., et al., Antimicrobial Chemotherapy 41(Suppl. A):41-6, 1998).Interestingly, the spectrum of responsible microorganisms appears tohave shifted from predominantly Gram-negative bacteria in the late 1970sand 1980s to predominantly Gram-positive bacteria at present, forreasons that are currently unclear (Martin, G. S., et al., N. Eng. J.Med. 348:1546-54, 2003).

Many studies have shown the importance of complement activation inmediating inflammation and contributing to the features of shock,particularly septic and hemorrhagic shock. Both Gram-negative andGram-positive organisms commonly precipitate septic shock. LPS is apotent activator of complement, predominantly via the alternativepathway, although classical pathway activation mediated by antibodiesalso occurs (Fearon, D. T., et al., N. Engl. J. Med. 292:937-400, 1975).The major components of the Gram-positive cell wall are peptidoglycanand lipoteichoic acid, and both components are potent activators of thealternative complement pathway, although in the presence of specificantibodies they can also activate the classical complement pathway(Joiner, K. A., et al., Ann. Rev. Immunol. 2:461-2, 1984).

The complement system was initially implicated in the pathogenesis ofsepsis when it was noted by researchers that anaphylatoxins C3a and C5amediate a variety of inflammatory reactions that might also occur duringsepsis. These anaphylatoxins evoke vasodilation and an increase inmicrovascular permeability, events that play a central role in septicshock (Schumacher, W. A., et al., Agents Actions 34:345-349, 1991). Inaddition, the anaphylatoxins induce bronchospasm, histamine release frommast cells, and aggregation of platelets. Moreover, they exert numerouseffects on granulocytes, such as chemotaxis, aggregation, adhesion,release of lysosomal enzymes, generation of toxic super oxide anion andformation of leukotrienes (Shin, H. S., et al., Science 162:361-363,1968; Vogt, W., Complement 3:177-86, 1986). These biologic effects arethought to play a role in development of complications of sepsis such asshock or acute respiratory distress syndrome (ARDS) (Hammerschmidt, D.E., et al., Lancet 1:947-949, 1980; Slotman, G. T., et al., Surgery99:744-50, 1986). Furthermore, elevated levels of the anaphylatoxin C3ais associated with a fatal outcome in sepsis (Hack, C. E., et al., Am.J. Med. 86:20-26, 1989). In some animal models of shock, certaincomplement-deficient strains (e.g., C5-deficient ones) are moreresistant to the effects of LPS infusions (Hseuh, W., et al., Immunol.70:309-14, 1990).

Blockade of C5a generation with antibodies during the onset of sepsis inrodents has been shown to greatly improve survival (Czermak, B. J., etal., Nat. Med. 5:788-792, 1999). Similar findings were made when the C5areceptor (C5aR) was blocked, either with antibodies or with a smallmolecular inhibitor (Huber-Lang, M. S., et al., FASEB 1 16:1567-74,2002; Riedemann, N. C., et al., J. Clin. Invest. 110:101-8, 2002).Earlier experimental studies in monkeys have suggested that antibodyblockade of C5a attenuated E. coli-induced septic shock and adultrespiratory distress syndrome (Hangen, D. H., et al., J. Surg. Res.46:195-9, 1989; Stevens, J. H., et al., J. Clin. Invest. 77:1812-16,1986). In humans with sepsis, C5a was elevated and associated withsignificantly reduced survival rates together with multiorgan failure,when compared with that in less severely septic patients and survivors(Nakae, H., et al., Res. Commun. Chem. Pathol. Pharmacol. 84:189-95,1994; Nakae, et al., Surg. Today 26:225-29, 1996; Bengtson, A., et al.,Arch. Surg. 123:645-649, 1988). The mechanisms by which C5a exerts itsharmful effects during sepsis are yet to be investigated in greaterdetail, but recent data suggest the generation of C5a during sepsissignificantly compromises innate immune functions of blood neutrophils(Huber-Lang, M. S., et al., J. Immunol. 169:3223-31, 2002), theirability to express a respiratory burst, and their ability to generatecytokines (Riedemann, N. C., et al., Immunity 19:193-202, 2003). Inaddition, C5a generation during sepsis appears to have procoagulanteffects (Laudes, I. J., et al., Am. J. Pathol. 160:1867-75, 2002). Thecomplement-modulating protein CI INH has also shown efficacy in animalmodels of sepsis and ARDS (Dickneite, G., Behring Ins. Mitt. 93:299-305,1993).

The lectin pathway may also have a role in pathogenesis of sepsis. MBLhas been shown to bind to a range of clinically important microorganismsincluding both Gram-negative and Gram-positive bacteria, and to activatethe lectin pathway (Neth, O., et al., Infect. Immun. 68:688, 2000).Lipoteichoic acid (LTA) is increasingly regarded as the Gram-positivecounterpart of LPS. It is a potent immunostimulant that induces cytokinerelease from mononuclear phagocytes and whole blood (Morath, S., et al.,J. Exp. Med. 195:1635, 2002; Morath, S., et al., Infect. Immun. 70:938,2002). Recently it was demonstrated that L-ficolin specifically binds toLTA isolated from numerous Gram-positive bacteria species, includingStaphylococcus aureus, and activates the lectin pathway (Lynch, N. J.,et al., J. Immunol. 172:1198-02, 2004). MBL also has been shown to bindto LTA from Enterococcus spp in which the polyglycerophosphate chain issubstituted with glycosyl groups), but not to LTA from nine otherspecies including S. aureus (Polotsky, V. Y., et al., Infect. Immun.64:380, 1996).

An aspect of the invention thus provides a method for treating sepsis ora condition resulting from sepsis, by administering a compositioncomprising a therapeutically effective amount of a MASP-2 inhibitoryagent in a pharmaceutical carrier to a subject suffering from sepsis ora condition resulting from sepsis including without limitation severesepsis, septic shock, acute respiratory distress syndrome resulting fromsepsis, and systemic inflammatory response syndrome. Related methods areprovided for the treatment of other blood disorders, includinghemorrhagic shock, hemolytic anemia, autoimmune thromboticthrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS) or othermarrow/blood destructive conditions, by administering a compositioncomprising a therapeutically effective amount of a MASP-2 inhibitoryagent in a pharmaceutical carrier to a subject suffering from such acondition. The MASP-2 inhibitory agent is administered to the subjectsystemically, such as by intra-arterial, intravenous, intramuscular,inhalational (particularly in the case of ARDS), subcutaneous or otherparenteral administration, or potentially by oral administration fornon-peptidergic agents. The MASP-2 inhibitory agent composition may becombined with one or more additional therapeutic agents to combat thesequelae of sepsis and/or shock. For advanced sepsis or shock or adistress condition resulting therefrom, the MASP-2 inhibitorycomposition may suitably be administered in a fast-acting dosage form,such as by intravenous or intra-arterial delivery of a bolus of asolution containing the MASP-2 inhibitory agent composition. Repeatedadministration may be carried out as determined by a physician until thecondition has been resolved.

Urogenital Conditions

The complement system has been implicated in several distinct urogenitaldisorders including painful bladder disease, sensory bladder disease,chronic abacterial cystitis and interstitial cystitis (Holm-Bentzen, M.,et al., J. Urol. 138:503-507, 1987), infertility (Cruz, et al., Biol.Reprod. 54:1217-1228, 1996), pregnancy (Xu, C., et al., Science287:498-507, 2000), fetomaternal tolerance (Xu, C., et al., Science287:498-507, 2000), and pre-eclampsia (Haeger, M., Int. J. Gynecol.Obstet. 43:113-127, 1993).

Painful bladder disease, sensory bladder disease, chronic abacterialcystitis and interstitial cystitis are ill-defined conditions of unknownetiology and pathogenesis, and, therefore, they are without any rationaltherapy. Pathogenetic theories concerning defects in the epitheliumand/or mucous surface coating of the bladder, and theories concerningimmunological disturbances, predominate (Holm-Bentzen, M., et al., J.Urol. 138:503-507, 1987). Patients with interstitial cystitis werereported to have been tested for immunoglobulins (IgA, G, M), complementcomponents (C1q, C3, C4) and for C1-esterase inhibitor. There was ahighly significant depletion of the serum levels of complement componentC4 (p less than 0.001) and immunoglobulin G was markedly elevated (pless than 0.001). This study suggests classical pathway activation ofthe complement system, and supports the possibility that a chronic localimmunological process is involved in the pathogenesis of the disease(Mattila, J., et al., Eur. Urol. 9:350-352, 1983). Moreover, followingbinding of autoantibodies to antigens in bladder mucosa, activation ofcomplement could be involved in the production of tissue injury and inthe chronic self-perpetuating inflammation typical of this disease(Helin, H., et al., Clin. Immunol. Immunopathol. 43:88-96, 1987).

In addition to the role of complement in urogenital inflammatorydiseases, reproductive functions may be impacted by the local regulationof the complement pathway.

Naturally occurring complement inhibitors have evolved to provide hostcells with the protection they need to control the body's complementsystem. Crry, a naturally-occurring rodent complement inhibitor that isstructurally similar to the human complement inhibitors, MCP and DAF,has been investigated to delineate the regulatory control of complementin fetal development. Interestingly, attempts to generate Crry−/− micewere unsuccessful.

Instead, it was discovered that homozygous Crry−/− mice died in utero.Crry−/− embryos survived until about 10 days post coitus, and survivalrapidly declined with death resulting from developmental arrest. Therewas also a marked invasion of inflammatory cells into the placentaltissue of Crry−/− embryos. In contrast, Crry+/+ embryos appeared to haveC3 deposited on the placenta. This suggests that complement activationhad occurred at the placenta level, and in the absence of complementregulation, the embryos died. Confirming studies investigated theintroduction of the Crry mutation onto a C3 deficient background. Thisrescue strategy was successful. Together, these data illustrate that thefetomaternal complement interface must be regulated. Subtle alterationsin complement regulation within the placenta might contribute toplacental dysfunction and miscarriage (Xu, C., et al., Science287:498-507, 2000).

Pre-eclampsia is a pregnancy-induced hypertensive disorder in whichcomplement system activation has been implicated but remainscontroversial (Haeger, M., Int. J. Gynecol. Obstet. 43:113-127, 1993).Complement activation in systemic circulation is closely related toestablished disease in pre-eclampsia, but no elevations were seen priorto the presence of clinical symptoms and, therefore, complementcomponents cannot be used as predictors of pre-eclampsia (Haeger, etal., Obstet. Gynecol. 78:46, 1991). However, increased complementactivation at the local environment of the placenta bed might overcomelocal control mechanisms, resulting in raised levels of anaphylatoxinsand C5b-9 (Haeger, et al., Obstet. Gynecol. 73:551, 1989).

One proposed mechanism of infertility related to antisperm antibodies(ASA) is through the role of complement activation in the genital tract.Generation of C3b and iC3b opsonin, which can potentiate the binding ofsperm by phagocytic cells via their complement receptors as well asformation of the terminal C5b-9 complex on the sperm surface, therebyreducing sperm motility, are potential causes associated with reducedfertility. Elevated C5b-9 levels have also been demonstrated in ovarianfollicular fluid of infertile women (D'Cruz, O. J., et al., J. Immunol.144:3841-3848, 1990). Other studies have shown impairment in spermmigration, and reduced sperm/egg interactions, which may be complementassociated (D'Cruz, O. J., et al., J. Immunol. 146:611-620, 1991;Alexander, N. J., Fertil. Steril. 41:433-439, 1984). Finally, studieswith sCR1 demonstrated a protective effect against ASA- and complementmediated injury to human sperm (D'Cruz, O. J., et al., Biol. Reprod.54:1217-1228, 1996). These data provide several lines of evidence forthe use of complement inhibitors in the treatment of urogenital diseaseand disorders.

An aspect of the invention thus provides a method for inhibitingMASP-2-dependent complement activation in a patient suffering from aurogenital disorder, by administering a composition comprising atherapeutically effective amount of a MASP-2 inhibitory agent in apharmaceutical carrier to a subject suffering from such a disorder.Urogenital disorders believed to be subject to therapeutic treatmentwith the methods and compositions of the present invention include, byway of nonlimiting example, painful bladder disease, sensory bladderdisease, chronic abacterial cystitis and interstitial cystitis, male andfemale infertility, placental dysfunction and miscarriage andpre-eclampsia. The MASP-2 inhibitory agent may be administered to thesubject systemically, such as by intra-arterial, intravenous,intramuscular, inhalational, subcutaneous or other parenteraladministration, or potentially by oral administration fornon-peptidergic agents. Alternately, the MASP-2 inhibitory compositionmay be delivered locally to the urogenital tract, such as byintravesical irrigation or instillation with a liquid solution or gelcomposition. Repeated administration may be carried out as determined bya physician to control or resolve the condition.

Diabetes And Diabetic Conditions

Diabetic retinal microangiopathy is characterized by increasedpermeability, leukostasis, microthrombosis, and apoptosis of capillarycells, all of which could be caused or promoted by activation ofcomplement. Glomerular structures and endoneurial microvessels ofpatients with diabetes show signs of complement activation. Decreasedavailability or effectiveness of complement inhibitors in diabetes hasbeen suggested by the findings that high glucose in vitro selectivelydecreases on the endothelial cell surface the expression of CD55 andCD59, the two inhibitors that are glycosylphosphatidylinositol(GPI)-anchored membrane proteins, and that CD59 undergoes nonenzymaticglycation that hinders its complement-inhibitory function.

Studies by Zhang et al. (Diabetes 51:3499-3504, 2002), investigatedcomplement activation as a feature of human nonproliferative diabeticretinopathy and its association with changes in inhibitory molecules. Itwas found that deposition of C5b-9, the terminal product of complementactivation, occurs in the wall of retinal vessels of human eye donorswith type-2 diabetes, but not in the vessels of age-matched nondiabeticdonors. C1q and C4, the complement components unique to the classicalpathway, were not detected in the diabetic retinas, which indicates thatC5b-9 was generated via the alternative pathway. The diabetic donorsshowed a prominent reduction in the retinal levels of CD55 and CD59, thetwo complement inhibitors linked to the plasma membrane by GPI anchors.Similar complement activation in retinal vessels and selective reductionin the levels of retinal CD55 and CD59 were observed in rats with a 10week duration of streptozotocin-induced diabetes. Thus, diabetes appearsto cause defective regulation of complement inhibitors and complementactivation that precede most other manifestations of diabetic retinalmicroangiopathy.

Gerl et al. (Investigative Ophthalmology and Visual Science 43:1104-08,2000) determined the presence of activated complement components in eyesaffected by diabetic retinopathy. Immunohistochemical studies foundextensive deposits of complement C5b-9 complexes that were detected inthe choriocapillaris immediately underlying the Bruch membrane anddensely surrounding the capillaries in all 50 diabetic retinopathyspecimens.

Staining for C3d positively correlated with C5b-9 staining, indicativeof the fact that complement activation had occurred in situ.Furthermore, positive staining was found for vitronectin, which formsstable complexes with extracellular C5b-9. In contrast, there was nopositive staining for C-reactive protein (CRP), mannan-binding lectin(MBL), C1q, or C4, indicating that complement activation did not occurthrough a C4-dependent pathway. Thus, the presence of C3d, C5b-9, andvitronectin indicates that complement activation occurs to completion,possibly through the alternative pathway in the choriocapillaris in eyesaffected by diabetic retinopathy. Complement activation may be acausative factor in the pathologic sequelae that can contribute toocular tissue disease and visual impairment. Therefore, the use of acomplement inhibitor may be an effective therapy to reduce or blockdamage to microvessels that occurs in diabetes.

Insulin dependent diabetes mellitus (IDDM, also referred to as Type-Idiabetes) is an autoimmune disease associated with the presence ofdifferent types of autoantibodies (Nicoloff et al., Clin. Dev. Immunol.11:61-66, 2004). The presence of these antibodies and the correspondingantigens in the circulation leads to the formation of circulating immunecomplexes (CIC), which are known to persist in the blood for longperiods of time. Deposition of CIC in the small blood vessels has thepotential to lead to microangiopathy with debilitating clinicalconsequences. A correlation exists between CIC and the development ofmicrovascular complications in diabetic children. These findings suggestthat elevated levels of CIC IgG are associated with the development ofearly diabetic nephropathy and that an inhibitor of the complementpathway may be effective at blocking diabetic nephropathy (Kotnik, etal., Croat. Med. 1 44:707-11, 2003). In addition, the formation ofdownstream complement proteins and the involvement of the alternativepathway is likely to be a contributory factor in overall islet cellfunction in IDDM, and the use of a complement inhibitor to reducepotential damage or limit cell death is expected (Caraher et al., J.Endocrinol. 162:143-53, 1999).

Circulating MBL concentrations are significantly elevated in patientswith type 1 diabetes compared to healthy controls, and these MBLconcentrations correlate positively with urinary albumin excretion(Hansen et al., J. Clin. Endocrinol. Metab. 88:4857-61, 2003). A recentclinical study found that the frequencies of high- and low-expressionMBL genotypes were similar between patients with type 1 diabetes andhealthy controls (Hansen et al., Diabetes 53:1570-76, 2004). However,the risk of having nephropathy among the diabetes patients wassignificantly increased if they had a high MBL genotype. This indicatesthat high MBL levels and lectin pathway complement activation maycontribute to the development of diabetic nephropathy. This conclusionis supported by a recent prospective study in which the associationbetween MBL levels and the development of albuminuria in a cohort ofnewly diagnosed type 1 diabetic patients was examined (Hovind et al.,Diabetes 54:1523-27, 2005). They found that high levels of MBL early inthe course of type 1 diabetes were significantly associated with laterdevelopment of persistent albuminuria. These results suggest that MBLand the lectin pathway may be involved in the specific pathogenesis ofdiabetic vascular complications more than merely causing an accelerationof existing alterations. In a recent clinical study (Hansen et al.,Arch. Intern. Med. 166:2007-13, 2006), MBL levels were measured atbaseline in a well-characterized cohort of patients with type 2 diabeteswho received more than 15 years of follow up. They found that even afteradjustment for known confounders, the risk of dying was significantlyhigher among patients with high MBL plasma levels (>1000 μg/L) thanamong patients with low MBL levels (<1000 μg/L).

In another aspect of the invention, methods are provided for inhibitingMASP-2-dependent complement activation in a subject suffering fromnonobese diabetes (IDDM) or from angiopathy, neuropathy or retinopathycomplications of IDDM or adult onset (Type-2) diabetes, by administeringa composition comprising a therapeutically effective amount of a MASP-2inhibitor in a pharmaceutical carrier. The MASP-2 inhibitory agent maybe administered to the subject systemically, such as by intra-arterial,intravenous, intramuscular, subcutaneous or other parenteraladministration, or potentially by oral administration fornon-peptidergic agents. Alternatively, administration may be by localdelivery to the site of angiopathic, neuropathic or retinopathicsymptoms. The MASP-2 inhibitory agent may be administered periodicallyover an extended period of time for treatment or control of a chroniccondition, or by a single or series of administrations for treatment ofan acute condition.

Perichemotherapeutic Administration and Treatment of Malignancies

Activation of the complement system may also be implicated in thepathogenesis of malignancies. Recently, the neoantigens of the C5b-9complement complex, IgG, C3, C4, S-protein/vitronectin, fibronectin, andmacrophages were localized on 17 samples of breast cancer and on 6samples of benign breast tumors using polyclonal or monoclonalantibodies and the streptavidin-biotin-peroxidase technique. All thetissue samples with carcinoma in each the TNM stages presented C5b-9deposits on the membranes of tumor cells, thin granules on cellremnants, and diffuse deposits in the necrotic areas (Niculescu, F., etal., Am. J. Pathol. 140:1039-1043, 1992).

In addition, complement activation may be a consequence of chemotherapyor radiation therapy and thus inhibition of complement activation wouldbe useful as an adjunct in the treatment of malignancies to reduceiatrogenic inflammation. When chemotherapy and radiation therapypreceded surgery, C5b-9 deposits were more intense and extended. TheC5b-9 deposits were absent in all the samples with benign lesions.S-protein/vitronectin was present as fibrillar deposits in theconnective tissue matrix and as diffuse deposits around the tumor cells,less intense and extended than fibronectin. IgG, C3, and C4 depositswere present only in carcinoma samples. The presence of C5b-9 depositsis indicative of complement activation and its subsequent pathogeneticeffects in breast cancer (Niculescu, F., et al., Am. J. Pathol.140:1039-1043, 1992).

Pulsed tunable dye laser (577 nm) (PTDL) therapy induces hemoglobincoagulation and tissue necrosis, which is mainly limited to bloodvessels. In a PTDL-irradiated normal skin study, the main findings wereas follows: 1) C3 fragments, C8, C9, and MAC were deposited in vesselwalls; 2) these deposits were not due to denaturation of the proteinssince they became apparent only 7 min after irradiation, contrary toimmediate deposition of transferrin at the sites of erythrocytecoagulates; 3) the C3 deposits were shown to amplify complementactivation by the alternative pathway, a reaction which was specificsince tissue necrosis itself did not lead to such amplification; and 4)these reactions preceded the local accumulation of polymorphonuclearleucocytes. Tissue necrosis was more pronounced in the hemangiomas. Thelarger angiomatous vessels in the center of the necrosis did not fixcomplement significantly. By contrast, complement deposition in thevessels situated at the periphery was similar to that observed in normalskin with one exception: C8, C9, and MAC were detected in some bloodvessels immediately after laser treatment, a finding consistent withassembly of the MAC occurring directly without the formation of a C5convertase. These results indicate that complement is activated inPTDL-induced vascular necrosis, and might be responsible for the ensuinginflammatory response.

Photodynamic therapy (PDT) of tumors elicits a strong host immuneresponse, and one of its manifestations is a pronounced neutrophilia. Inaddition to complement fragments (direct mediators) released as aconsequence of PDT-induced complement activation, there are at least adozen secondary mediators that all arise as a result of complementactivity. The latter include cytokines IL-1beta, TNF-alpha, IL-6, IL-10,G-CSF and KC, thromboxane, prostaglandins, leukotrienes, histamine, andcoagulation factors (Cecic, I., et al., Cancer Lett. /83:43-51, 2002).

Finally, the use of inhibitors of MASP-2-dependent complement activationmay be envisioned in conjunction with the standard therapeutic regimenfor the treatment of cancer.

For example, treatment with rituximab, a chimeric anti-CD20 monoclonalantibody, can be associated with moderate to severe first-doseside-effects, notably in patients with high numbers of circulating tumorcells. Recent studies during the first infusion of rituximab measuredcomplement activation products (C3b/c and C4b/c) and cytokines (tumournecrosis factor alpha (TNF-alpha), interleukin 6 (IL-6) and IL-8) infive relapsed low-grade non-Hodgkin's lymphoma (NHL) patients. Infusionof rituximab induced rapid complement activation, preceding the releaseof TNF-alpha, IL-6 and IL-8. Although the study group was small, thelevel of complement activation appeared to be correlated both with thenumber of circulating B cells prior to the infusion (r=0.85; P=0.07),and with the severity of the side-effects. The results indicated thatcomplement plays a pivotal role in the pathogenesis of side-effects ofrituximab treatment. As complement activation cannot be prevented bycorticosteroids, it may be relevant to study the possible role ofcomplement inhibitors during the first administration of rituximab (vander Kolk, L. E., et al., Br. J. Haematol. 115:807-811, 2001).

In another aspect of the invention, methods are provided for inhibiting

MASP-2-dependent complement activation in a subject being treated withchemotherapeutics and/or radiation therapy, including without limitationfor the treatment of cancerous conditions. This method includesadministering a composition comprising a therapeutically effectiveamount of a MASP-2 inhibitor in a pharmaceutical carrier to a patientperichemotherapeutically, i.e., before and/or during and/or after theadministration of chemotherapeutic(s) and/or radiation therapy. Forexample, administration of a MASP-2 inhibitor composition of the presentinvention may be commenced before or concurrently with theadministration of chemo- or radiation therapy, and continued throughoutthe course of therapy, to reduce the detrimental effects of the chemo-and/or radiation therapy in the non-targeted, healthy tissues. Inaddition, the MASP-2 inhibitor composition can be administered followingchemo- and/or radiation therapy. It is understood that chemo- andradiation therapy regimens often entail repeated treatments and,therefore, it is possible that administration of a MASP-2 inhibitorcomposition would also be repetitive and relatively coincident with thechemotherapeutic and radiation treatments. It is also believed thatMASP-2 inhibitory agents may be used as chemotherapeutic agents, aloneor in combination with other chemotherapeutic agents and/or radiationtherapy, to treat patients suffering from malignancies. Administrationmay suitably be via oral (for non-peptidergic), intravenous,intramuscular or other parenteral route.

Endocrine Disorders

The complement system has also been recently associated with a fewendocrine conditions or disorders including Hashimoto's thyroiditis(Blanchin, S., et al., Exp. Eye Res. 73(6):887-96, 2001), stress,anxiety and other potential hormonal disorders involving regulatedrelease of prolactin, growth or insulin-like growth factor, andadrenocorticotropin from the pituitary (Francis, K., et al., FASEB J.17:2266-2268, 2003; Hansen, T. K., Endocrinology 144(12):5422-9, 2003).

Two-way communication exists between the endocrine and immune systemsusing molecules such as hormones and cytokines. Recently, a new pathwayhas been elucidated by which C3a, a complement-derived cytokine,stimulates anterior pituitary hormone release and activates thehypothalamic-pituitary-adrenal axis, a reflex central to the stressresponse and to the control of inflammation. C3a receptors are expressedin pituitary-hormone-secreting and non-hormone-secreting(folliculostellate) cells. C3a and C3adesArg (a non-inflammatorymetabolite) stimulate pituitary cell cultures to release prolactin,growth hormone, and adrenocorticotropin. Serum levels of these hormones,together with adrenal corticosterone, increase dose dependently withrecombinant C3a and C3adesArg administration in vivo. The implication isthat complement pathway modulates tissue-specific and systemicinflammatory responses through communication with the endocrinepituitary gland (Francis, K., et al., FASEB J. 17:2266-2268, 2003).

An increasing number of studies in animals and humans indicate thatgrowth hormone (GH) and insulin-like growth factor-I (IGF-I) modulateimmune function. GH therapy increased the mortality in critically illpatients. The excessive mortality was almost entirely due to septicshock or multi-organ failure, which could suggest that a GH-inducedmodulation of immune and complement function was involved.Mannan-binding lectin (MBL) is a plasma protein that plays an importantrole in innate immunity through activation of the complement cascade andinflammation following binding to carbohydrate structures. Evidencesupports a significant influence from growth hormone on MBL levels and,therefore, potentially on lectin-dependent complement activation(Hansen, T. K., Endocrinology 144(12):5422-9, 2003).

Thyroperoxidase (TPO) is one of the main autoantigens involved inautoimmune thyroid diseases. TPO consists of a large N-terminalmyeloperoxidase-like module followed by a complement control protein(CCP)-like module and an epidermal growth factor-like module. The CCPmodule is a constituent of the molecules involved in the activation ofC4 complement component, and studies were conducted to investigatewhether C4 may bind to TPO and activate the complement pathway inautoimmune conditions. TPO via its CCP module directly activatescomplement without any mediation by Ig. Moreover, in patients withHashimoto's thyroiditis, thyrocytes overexpress C4 and all thedownstream components of the complement pathway. These results indicatethat TPO, along with other mechanisms related to activation of thecomplement pathway, may contribute to the massive cell destructionobserved in Hashimoto's thyroiditis (Blanchin, S., et al., 2001).

An aspect of the invention thus provides a method for inhibitingMASP-2-dependent complement activation to treat an endocrine disorder,by administering a composition comprising a therapeutically effectiveamount of a MASP-2 inhibitory agent in a pharmaceutical carrier to asubject suffering from an endocrine disorder. Conditions subject totreatment in accordance with the present invention include, by way ofnonlimiting example, Hashimoto's thyroiditis, stress, anxiety and otherpotential hormonal disorders involving regulated release of prolactin,growth or insulin-like growth factor, and adrenocorticotropin from thepituitary. The MAS-2 inhibitory agent may be administered to the subjectsystemically, such as by intra-arterial, intravenous, intramuscular,inhalational, nasal, subcutaneous or other parenteral administration, orpotentially by oral administration for non-peptidergic agents. TheMASP-2 inhibitory agent composition may be combined with one or moreadditional therapeutic agents. Administration may be repeated asdetermined by a physician until the condition has been resolved.

Ophthalmologic Conditions

Age-related macular degeneration (AMD) is a blinding disease thatafflicts millions of adults, yet the sequelae of biochemical, cellular,and/or molecular events leading to the development of AMD are poorlyunderstood. AMD results in the progressive destruction of the maculawhich has been correlated with the formation of extracellular depositscalled drusen located in and around the macula, behind the retina andbetween the retina pigment epithelium (RPE) and the choroid. Recentstudies have revealed that proteins associated with inflammation andimmune-mediated processes are prevalent among drusen-associatedconstituents. Transcripts that encode a number of these molecules havebeen detected in retinal, RPE, and choroidal cells. These data alsodemonstrate that dendritic cells, which are potent antigen-presentingcells, are intimately associated with drusen development, and thatcomplement activation is a key pathway that is active both within drusenand along the RPE-choroid interface (Hageman, G. S., et al., Prog.Retin. Eye Res. 20:705-732, 2001).

Several independent studies have shown a strong association between AMDand a genetic polymorphism in the gene for complement factor H (CFH) inwhich the likelihood of AMD is increased by a factor of 7.4 inindividuals homozygous for the risk allele (Klein, R. J. et al., Science308:362-364, 2005; Haines et al., Science 308:362-364. 2005; Edwards etal., Science 308:263-264, 2005). The CFH gene has been mapped tochromosome 1q31 a region that had been implicated in AMD by sixindependent linkage scans (see, e.g., Schultz, D. W., et al., Hum. Mol.Genet. 12:3315, 2003). CFH is known to be a key regulator of thecomplement system. It has been shown that CFH on cells and incirculation regulates complement activity by inhibiting the activationof C3 to C3a and C3b, and by inactivating existing C3b. Deposition ofC5b-9 has been observed in Brusch's membrane, the intercapillary pillarsand within drusen in patients with AMD (Klein et al.).Immunofluorescence experiments suggest that in AMD, the polymorphism ofCFH may give rise to complement deposition in chorodial capillaries andchorodial vessels (Klein et al.).

The membrane-associated complement inhibitor, complement receptor 1, isalso localized in drusen, but it is not detected in RPE cellsimmunohistochemically. In contrast, a second membrane-associatedcomplement inhibitor, membrane cofactor protein, is present indrusen-associated RPE cells, as well as in small, sphericalsubstructural elements within drusen. These previously unidentifiedelements also show strong immunoreactivity for proteolytic fragments ofcomplement component C3 that are characteristically deposited at sitesof complement activation. It is proposed that these structures representresidual debris from degenerating RPE cells that are the targets ofcomplement attack (Johnson, L. V., et al., Exp. Eye Res. 73:887-896,2001).

Identification and localization of these multiple complement regulatorsas well as complement activation products (C3a, C5a, C3b, C5b-9) haveled investigators to conclude that chronic complement activation playsan important role in the process of drusen biogenesis and the etiologyof AMD (Hageman et al., Progress Retinal Eye Res. 20:705-32, 2001).Identification of C3 and C5 activation products in drusen provides noinsight into whether complement is activated via the classical pathway,the lectin pathway or the alternative amplification loop, as understoodin accordance with the present invention, since both C3 and C5 arecommon to all three. However, two studies have looked for drusenimmuno-labeling using antibodies specific to C1q, the essentialrecognition component for activation of the classical pathway (Mullinset al., FASEB J. 14:835-846, 2000; Johnson et al., Exp. Eye Res.70:441-449, 2000). Both studies concluded that C1q immuno-labelling indrusen was not generally observed. These negative results with C1qsuggest that complement activation in drusen does not occur via theclassical pathway. In addition, immuno-labeling of drusen forimmune-complex constituents (IgG light chains, IgM) is reported in theMullins et al., 2000 study as being weak to variable, further indicatingthat the classical pathway plays a minor role in the complementactivation that occurs in this disease process.

Two recent published studies have evaluated the role of complement inthe development of laser-induced choroidal neovascularization (CNV) inmice, a model of human CNV. Using immunohistological methods, Bora andcolleagues (2005) found significant deposition of the complementactivation products C3b and C5b-9 (MAC) in the neovascular complexfollowing laser treatment (Bora et al., J. Immunol. 174:491-7, 2005).Importantly, CNV did not develop in mice genetically deficient in C3(C3−/− mice), the essential component required in all complementactivation pathways. RNA message levels for VEGF, TGF-β₂, and β-FGF,three angiogenic factors implicated in CNV, were elevated in eye tissuefrom mice after laser-induced CNV. Significantly, complement depletionresulted in a marked reduction in the RNA levels of these angiogenicfactors.

Using ELISA methods, Nozaki and colleagues demonstrated that the potentanaphylatoxins C3a and C5a are generated early in the course oflaser-induced CNV (Nozaki et al., Proc. Natl. Acad. Sci. U.S.A.103:2328-33, 2006). Furthermore, these two bioactive fragments of C3 andC5 induced VEGF expression following intravitreal injection in wild-typemice. Consistent with these results Nozaki and colleagues also showedthat genetic ablation of receptors for C3a and C5a reduces VEGFexpression and CNV formation after laser injury, and thatantibody-mediated neutralization of C3a or C5a or pharmacologic blockadeof their receptors also reduces CNV. Previous studies have establishedthat recruitment of leukocytes, and macrophages in particular, plays apivotal role in laser-induced CNV (Sakurai et al., Invest. Opthomol.Vis. Sci. 44:3578-85, 2003; Espinosa-Heidmann, et al., Invest. Opthomol.Vis. Sci. 44:3586-92, 2003). In their 2006 paper, Nozaki and colleaguesreport that leukocyte recruitment is markedly reduced in C3aR(−/−) andC5aR(−/−) mice after laser injury.

An aspect of the invention thus provides a method for inhibitingMASP-2-dependent complement activation to treat age-related maculardegeneration or other complement mediated ophthalmologic condition byadministering a composition comprising a therapeutically effectiveamount of a MASP-2 inhibitory agent in a pharmaceutical carrier to asubject suffering from such a condition or other complement-mediatedophthalmologic condition. The MASP-2 inhibitory composition may beadministered locally to the eye, such as by irrigation or application ofthe composition in the form of a gel, salve or drops. Alternately, theMASP-2 inhibitory agent may be administered to the subject systemically,such as by intra-arterial, intravenous, intramuscular, inhalational,nasal, subcutaneous or other parenteral administration, or potentiallyby oral administration for non-peptidergic agents. The MASP-2 inhibitoryagent composition may be combined with one or more additionaltherapeutic agents, such as are disclosed in U.S. Patent ApplicationPublication No. 2004-0072809-Al. Administration may be repeated asdetermined by a physician until the condition has been resolved or iscontrolled.

Coagulopathies

Evidence has been developed for the role of the complement system indisseminated intravascular coagulation (“DIC”), such as DIC secondary tosignificant bodily trauma.

Previous studies have shown that C4−/− mice are not protected from renalreperfusion injury. (Zhou, W., et al, “Predominant role for C5b-9 inrenal ischemia/reperfusion injury,” J Clin Invest 105:1363-1371 (2000))In order to investigate whether C4−/− mice may still be able to activatecomplement via either the classical or the lectin pathway, C3 turn-overin C4-/− plasma was measured in assays specific for either theclassical, or the lectin pathway activation route. While no C3 cleavagecould be observed when triggering activation via the classical, a highlyefficient lectin pathway-dependent activation of C3 in C4 deficientserum was observed (FIG. 30). It can be seen that C3b deposition onmannan and zymosan is severely compromised in MASP-2−/− mice, even underexperimental conditions, that according to many previously publishedpapers on alternative pathway activation, should be permissive for allthree pathways. When using the same sera in wells coated withimmunoglobulin complexes instead of mannan or zymosan, C3b depositionand Factor B cleavage are seen in MASP-2+/+ mouse sera and MASP-2−/−sera, but not in C1q depleted sera. This indicates that alternatepathway activation is facilitated in MASP-2−/− sera when the initial C3bis provided via classical activity. FIG. 30C depicts the surprisingfinding that C3 can efficiently be activated in a lectinpathway-dependent fashion in C4 deficient plasma.

This “C4 bypass” is abolished by the inhibition of lectinpathway-activation through preincubation of plasma with soluble mannanor mannose.

Aberrant, non-immune, activation of the complement system is potentiallyhazardous to man and may also play an important role in hematologicalpathway activation, particularly in severe trauma situations whereinboth inflammatory and hematological pathways are activated. In normalhealth, C3 conversion is <5% of the total plasma C3 protein. In rampantinfection, including septicaemia and immune complex disease, C3conversion re-establishes itself at about 30% with complement levelsfrequently lower than normal, due to increased utilization and changesin pool distribution. Immediate C3 pathway activation of greater than30% generally produces obvious clinical evidence of vasodilatation andof fluid loss to the tissues. Above 30% C3 conversion, the initiatingmechanisms are predominantly non-immune and the resulting clinicalmanifestations are harmful to the patient. Complement C5 levels inhealth and in controlled disease appear much more stable than C3.Significant decreases and or conversion of C5 levels are associated withthe patient's response to abnormal polytrauma (e.g., road trafficaccidents) and the likely development of shock lung syndromes. Thus, anyevidence of either complement C3 activation beyond 30% of the vascularpool or of any C5 involvement, or both, may be considered likely to be aharbinger of a harmful pathological change in the patient.

Both C3 and C5 liberate anaphylatoxins (C3a and C5a) that act on mastcells and basophils releasing vasodilatory chemicals. They set upchemotactic gradients to guide polymorphonuclear cells (PMN) to thecenter of immunological disturbances (a beneficial response), but herethey differ because C5a has a specific clumping (aggregating) effect onthese phagocytic cells, preventing their random movement away from thereaction site. In normal control of infection, C3 activates C5. However,in polytrauma, C5 appears to be widely activated, generating C5aanaphylatoxins systemically. This uncontrolled activity causespolymorphs to clump within the vascular system, and these clumps arethen swept into the capillaries of the lungs, which they occlude andgenerate local damaging effects as a result of superoxide liberation.While not wishing to be limited by theory, the mechanism is probablyimportant in the pathogenesis of acute respiratory distress syndrome(ARDS), although this view has recently been challenged. The C3aanaphylatoxins in vitro can be shown to be potent platelet aggregators,but their involvement in vivo is less defined and the release ofplatelet substances and plasmin in wound repair may only secondarilyinvolve complement C3. It is possible that prolonged elevation of C3activation is necessary to generate DIC.

In addition to cellular and vascular effects of activated complementcomponent outlined above that could explain the link between trauma andDIC, emerging scientific discoveries have identified direct molecularlinks and functional cross-talk between complement and coagulationsystems. Supporting data has been obtained from studies in C3 deficientmice. Because C3 is the shared component for each of the complementpathways, C3 deficient mice are predicted to lack all complementfunction. Surprisingly, however, C3 deficient mice are perfectly capableof activating terminal complement components. (Huber-Lang, M., et al.,“Generation of C5a in the absence of C3: a new complement activationpathway,” Nat. Med 12:682-687 (2006)) In depth studies revealed thatC3-independent activation of terminal complement components is mediatedby thrombin, the rate limiting enzyme of the coagulation cascade. (Huberet al., 2006) The molecular components mediating thrombin activationfollowing initial complement activation remained elusive.

The present inventors have elucidated what is believed to be themolecular basis for cross-talk between complement and clotting cascadesand identified MASP-2 as a central control point linking the twosystems. Biochemical studies into the substrate specificity of MASP-2have identified prothrombin as a possible substrate, in addition to thewell known C2 and C4 complement proteins. MASP-2 specifically cleavesprothrombin at functionally relevant sites, generating thrombin, therate limiting enzyme of the coagulation cascade. (Krarup, A., et al.,“Simultaneous Activation of Complement and Coagulation by MBL-AssociatedSerine Protease 2,” PLoS. ONE. 2:e623 (2007)) MASP-2-generated thrombinis capable of promoting fibrin deposition in a defined reconstituted invitro system, demonstrating the functional relevance of MASP-2 cleavage.(Krarup et al., 2007) As discussed in the examples herein below, theinventors have further corroborated the physiological significance ofthis discovery by documenting thrombin activation in normal rodent serumfollowing lectin pathway activation, and demonstrated that this processis blocked by neutralizing MASP-2 monoclonal antibodies.

MASP-2 may represent a central branch point in the lectin pathway,capable of promoting activation of both complement and coagulationsystems. Because lectin pathway activation is a physiologic response tomany types of traumatic injury, the present inventors believe thatconcurrent systemic inflammation (mediated by complement components) anddisseminated coagulation (mediated via the clotting pathway) can beexplained by the capacity of MASP-2 to activate both pathways. Thesefindings clearly suggest a role for

MASP-2 in DIC generation and therapeutic benefit of MASP-2 inhibition intreating or preventing DIC. MASP-2 may provide the molecular linkbetween complement and coagulation system, and activation of the lectinpathway as it occurs in settings of trauma can directly initiateactivation of the clotting system via the MASP-2-thrombin axis,providing a mechanistic link between trauma and DIC. In accordance withan aspect of the present invention, inhibition of MASP-2 would inhibitlectin pathway activation and reduce the generation of bothanaphylatoxins C3a and C5a. It is believed that prolonged elevation ofC3 activation is necessary to generate DIC.

Therefore, an aspect of the invention thus provides a method forinhibiting MASP-2-dependent complement activation to treat disseminatedintravascular coagulation or other complement mediated coagulationdisorder by administering a composition comprising a therapeuticallyeffective amount of a MASP-2 inhibitory agent (e.g., anti-MASP-2antibody or fragment thereof, peptide inhibitors or small moleculeinhibitors) in a pharmaceutical carrier to a subject suffering from orat risk for developing such a condition. In some embodiments, the MASP-2inhibitory agents can block MASP-2 that has already been activated. TheMASP-2 inhibitory composition is suitably administered to the subjectsystemically, such as by intra-arterial, intravenous, intramuscular,inhalational, nasal, subcutaneous or other parenteral administration, orpotentially by oral administration for non-peptidergic agents.Administration may be repeated as determined by a physician until thecondition has been resolved or is controlled. The methods of this aspectof the present invention may be utilized for treatment of DIC secondaryto sepsis, severe trauma, including neurological trauma (e.g., acutehead injury, see Kumura, E., et al., Acta Neurochirurgica 85:23-28(1987), infection (bacterial, viral, fungal, parasitic), cancer,obstetrical complications, liver disease, severe toxic reaction (e.g.,snake bite, insect bite, transfusion reaction), shock, heat stroke,transplant rejection, vascular aneurysm, hepatic failure, cancertreatment by chemotherapy or radiation therapy, burn, accidentalradiation exposure, and other causes. See e.g., Becker J. U. and Wira C.R. “Disseminated Intravascular Coagulation”emedicine.medscape.com/9/10/2009. For DIC secondary to trauma or otheracute event, the MASP-2 inhibitory composition may be administeredimmediately following the traumatic injury or prophylactically prior to,during, immediately following, or within one to seven days or longer,such as within 24 hours to 72 hours, after trauma-inducing injury orsituations such as surgery in patients deemed at risk of DIC. In someembodiments, the MASP-2 inhibitory composition may suitably beadministered in a fast-acting dosage form, such as by intravenous orintra-arterial delivery of a bolus of a solution containing the MASP-2inhibitory agent composition.

IV. MASP-2 INHIBITORY AGENTS

In one aspect, the present invention provides methods of inhibiting theadverse effects of MASP-2-dependent complement activation. MASP-2inhibitory agents are administered in an amount effective to inhibitMASP-2-dependent complement activation in a living subject. In thepractice of this aspect of the invention, representative MASP-2inhibitory agents include: molecules that inhibit the biologicalactivity of MASP-2 (such as small molecule inhibitors, anti-MASP-2antibodies or blocking peptides which interact with MASP-2 or interferewith a protein-protein interaction), and molecules that decrease theexpression of MASP-2 (such as MASP-2 antisense nucleic acid molecules,MASP-2 specific RNAi molecules and MASP-2 ribozymes), thereby preventingMASP-2 from activating the alternative complement pathways. The MASP-2inhibitory agents can be used alone as a primary therapy or incombination with other therapeutics as an adjuvant therapy to enhancethe therapeutic benefits of other medical treatments.

The inhibition of MASP-2-dependent complement activation ischaracterized by at least one of the following changes in a component ofthe complement system that occurs as a result of administration of aMASP-2 inhibitory agent in accordance with the methods of the invention:the inhibition of the generation or production of MASP-2-dependentcomplement activation system products C4b, C3a, C5a and/or C5b-9 (MAC)(measured, for example, as described in Example 2), the reduction ofalternative complement activation assessed in a hemolytic assay usingunsensitized rabbit or guinea pig red blood cells , the reduction of C4cleavage and C4b deposition (measured, for example as described inExample 2), or the reduction of C3 cleavage and C3b deposition(measured, for example, as described in Example 2).

According to the present invention, MASP-2 inhibitory agents areutilized that are effective in inhibiting the MASP-2-dependentcomplement activation system. MASP-2 inhibitory agents useful in thepractice of this aspect of the invention include, for example,anti-MASP-2 antibodies and fragments thereof, MASP-2 inhibitorypeptides, small molecules, MASP-2 soluble receptors and expressioninhibitors. MASP-2 inhibitory agents may inhibit the MASP-2-dependentcomplement activation system by blocking the biological function ofMASP-2. For example, an inhibitory agent may effectively block MASP-2protein-to-protein interactions, interfere with MASP-2 dimerization orassembly, block Ca²⁺ binding, interfere with the MASP-2 serine proteaseactive site, or may reduce MASP-2 protein expression.

In some embodiments, the MASP-2 inhibitory agents selectively inhibitMASP-2 complement activation, leaving the C1q-dependent complementactivation system functionally intact.

In one embodiment, a MASP-2 inhibitory agent useful in the methods ofthe invention is a specific MASP-2 inhibitory agent that specificallybinds to a polypeptide comprising SEQ ID NO:6 with an affinity of atleast ten times greater than to other antigens in the complement system.In another embodiment, a MASP-2 inhibitory agent specifically binds to apolypeptide comprising SEQ ID NO:6 with a binding affinity of at least100 times greater than to other antigens in the complement system. Thebinding affinity of the MASP-2 inhibitory agent can be determined usinga suitable binding assay.

The MASP-2 polypeptide exhibits a molecular structure similar to MASP-1,MASP-3, and C1r and C1s, the proteases of the C1 complement system. ThecDNA molecule set forth in SEQ ID NO:4 encodes a representative exampleof MASP-2 (consisting of the amino acid sequence set forth in SEQ IDNO:5) and provides the human MASP-2 polypeptide with a leader sequence(aa 1-15) that is cleaved after secretion, resulting in the mature formof human MASP-2 (SEQ ID NO:6). As shown in FIG. 2, the human MASP 2 geneencompasses twelve exons. The human MASP-2 cDNA is encoded by exons B,C, D, F, G, H, I, J, K AND L. An alternative splice results in a 20 kDaprotein termed MBL-associated protein 19 (“MAp19”, also referred to as“sMAP”) (SEQ ID NO:2), encoded by (SEQ ID NO:1) arising from exons B, C,D and E as shown in FIG. 2. The cDNA molecule set forth in SEQ ID NO:50encodes the murine MASP-2 (consisting of the amino acid sequence setforth in SEQ ID NO:51) and provides the murine MASP-2 polypeptide with aleader sequence that is cleaved after secretion, resulting in the matureform of murine MASP-2 (SEQ ID NO:52). The cDNA molecule set forth in SEQID NO:53 encodes the rat MASP-2 (consisting of the amino acid sequenceset forth in SEQ ID NO:54) and provides the rat MASP-2 polypeptide witha leader sequence that is cleaved after secretion, resulting in themature form of rat MASP-2 (SEQ ID NO:55).

Those skilled in the art will recognize that the sequences disclosed inSEQ ID NO:4, SEQ ID NO:50 and SEQ ID NO:53 represent single alleles ofhuman, murine and rat MASP-2 respectively, and that allelic variationand alternative splicing are expected to occur. Allelic variants of thenucleotide sequences shown in SEQ ID NO:4, SEQ ID NO:50 and SEQ IDNO:53, including those containing silent mutations and those in whichmutations result in amino acid sequence changes, are within the scope ofthe present invention. Allelic variants of the MASP-2 sequence can becloned by probing cDNA or genomic libraries from different individualsaccording to standard procedures.

The domains of the human MASP-2 protein (SEQ ID NO:6) are shown in FIG.3A and include an N-terminal C1r/C1s/sea urchin Vegf/bone morphogenicprotein (CUBI) domain (aa 1-121 of SEQ ID NO:6), an epidermal growthfactor-like domain (aa 122-166), a second CUBI domain (aa 167-293), aswell as a tandem of complement control protein domains and a serineprotease domain. Alternative splicing of the MASP 2 gene results inMAp19 shown in FIG. 3B. MAp19 is a nonenzymatic protein containing theN-terminal CUB1-EGF region of MASP-2 with four additional residues(EQSL) derived from exon E as shown in FIG. 2.

Several proteins have been shown to bind to, or interact with MASP-2through protein-to-protein interactions. For example, MASP-2 is known tobind to, and form Ca²⁺ dependent complexes with, the lectin proteinsMBL, H-ficolin and L-ficolin. Each MASP-2/lectin complex has been shownto activate complement through the MASP-2-dependent cleavage of proteinsC4 and C2 (Ikeda, K., et al., J. Biol. Chem. 262:7451-7454, 1987;Matsushita, M., et al., J. Exp. Med. 176:1497-2284, 2000; Matsushita,M., et al., J. Immunol. 168:3502-3506, 2002). Studies have shown thatthe CUB1-EGF domains of MASP-2 are essential for the association ofMASP-2 with MBL (Thielens, N. M., et al., J. Immunol. 166:5068, 2001).It has also been shown that the CUB 1EGFCUBII domains mediatedimerization of MASP-2, which is required for formation of an active MBLcomplex (Wallis, R., et al., J. Biol. Chem. 275:30962-30969, 2000).Therefore, MASP-2 inhibitory agents can be identified that bind to orinterfere with MASP-2 target regions known to be important forMASP-2-dependent complement activation.

Anti-MASP-2 Antibodies

In some embodiments of this aspect of the invention, the MASP-2inhibitory agent comprises an anti-MASP-2 antibody that inhibits theMASP-2-dependent complement activation system. The anti-MASP-2antibodies useful in this aspect of the invention include polyclonal,monoclonal or recombinant antibodies derived from any antibody producingmammal and may be multispecific, chimeric, humanized, anti-idiotype, andantibody fragments. Antibody fragments include Fab, Fab′, F(ab)₂,F(ab′)₂, Fv fragments, scFv fragments and single-chain antibodies asfurther described herein.

Several anti-MASP-2 antibodies have been described in the literature,some of which are listed below in TABLE 1. These previously describedanti-MASP-2 antibodies can be screened for the ability to inhibit theMASP-2-dependent complement activation system using the assays describedherein. For example, anti rat MASP-2 Fab2 antibodies have beenidentified that block MASP-2 dependent complement activation, asdescribed in more detail in Examples 24 and 25 herein. Once ananti-MASP-2 antibody is identified that functions as a MASP-2 inhibitoryagent, it can be used to produce anti-idiotype antibodies and used toidentify other MASP-2 binding molecules as further described below.

TABLE 1 MASP-2 SPECIFIC ANTIBODIES FROM THE LITERATURE ANTIGEN ANTIBODYTYPE REFERENCE Recombinant Rat Polyclonal Peterson, S. V., et al.,MASP-2 Mol. Immunol. 37: 803-811, 2000 Recombinant human Rat MoAbMoller-Kristensen, M., CCP1/2-SP (subclass IgG1) et al., J. of Immunol.fragment Methods 282: 159-167, (MoAb 8B5) 2003 Recombinant human RatMoAb Moller-Kristensen, M., MAp19 (MoAb (subclass IgG1) et al., J. ofImmunol. 6G12) (cross reacts Methods 282: 159-167, with MASP-2) 2003hMASP-2 Mouse MoAb (S/P) Peterson, S. V., et al., Mouse MoAb (N-term)Mol. Immunol. 35: 409, April 1998 hMASP-2 rat MoAb: Nimoab101, WO2004/106384 (CCP1-CCP2-SP produced by hybridoma domain cell line03050904 (ECACC) hMASP-2 (full murine MoAbs: WO 2004/106384 length-histagged) NimoAb104, produced by hybridoma cell line M0545YM035 (DSMZ)NimoAb108, produced by hybridoma cell line M0545YM029 (DSMZ) NimoAb109produced by hybridoma cell line M0545YM046 (DSMZ) NimoAb110 produced byhybridoma cell line M0545YM048 (DSMZ)

Anti-MASP-2 Antibodies with Reduced Effector Function

In some embodiments of this aspect of the invention, the anti-MASP-2antibodies have reduced effector function in order to reduceinflammation that may arise from the activation of the classicalcomplement pathway. The ability of IgG molecules to trigger theclassical complement pathway has been shown to reside within the Fcportion of the molecule (Duncan, A. R., et al., Nature 332:738-7401988). IgG molecules in which the Fc portion of the molecule has beenremoved by enzymatic cleavage are devoid of this effector function (seeHarlow, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory,New York, 1988). Accordingly, antibodies with reduced effector functioncan be generated as the result of lacking the Fc portion of the moleculeby having a genetically engineered Fc sequence that minimizes effectorfunction, or being of either the human IgG₂ or IgG₄ isotype.

Antibodies with reduced effector function can be produced by standardmolecular biological manipulation of the Fc portion of the IgG heavychains as described in Example 9 herein and also described in Jolliffeet al., Int'l Rev. Immunol. 10:241-250, 1993, and Rodrigues et al., J.Immunol. 151:6954-6961, 1998. Antibodies with reduced effector functionalso include human IgG2 and IgG4 isotypes that have a reduced ability toactivate complement and/or interact with Fc receptors (Ravetch, J. V.,et al., Annu. Rev. Immunol. 9:457-492, 1991; Isaacs, J. D., et al., J.Immunol. 148:3062-3071, 1992; van de Winkel, J. G., et al., Immunol.Today 14:215-221, 1993). Humanized or fully human antibodies specific tohuman MASP-2 comprised of IgG2 or IgG4 isotypes can be produced by oneof several methods known to one of ordinary skilled in the art, asdescribed in Vaughan, T. J., et al., Nature Biotechnical 16:535-539,1998.

Production of Anti-MASP-2 Antibodies

Anti-MASP-2 antibodies can be produced using MASP-2 polypeptides (e.g.,full length MASP-2) or using antigenic MASP-2 epitope-bearing peptides(e.g., a portion of the MASP-2 polypeptide). Immunogenic peptides may beas small as five amino acid residues. For example, the MASP-2polypeptide including the entire amino acid sequence of SEQ ID NO:6 maybe used to induce anti-MASP-2 antibodies useful in the method of theinvention. Particular MASP-2 domains known to be involved inprotein-protein interactions, such as the CUBI, and CUBIEGF domains, aswell as the region encompassing the serine-protease active site, may beexpressed as recombinant polypeptides as described in Example 5 and usedas antigens. In addition, peptides comprising a portion of at least 6amino acids of the MASP-2 polypeptide (SEQ ID NO:6) are also useful toinduce MASP-2 antibodies. Additional examples of MASP-2 derived antigensuseful to induce MASP-2 antibodies are provided below in TABLE 2. TheMASP-2 peptides and polypeptides used to raise antibodies may beisolated as natural polypeptides, or recombinant or synthetic peptidesand catalytically inactive recombinant polypeptides, such as MASP-2A, asfurther described in Examples 5-7. In some embodiments of this aspect ofthe invention, anti-MASP-2 antibodies are obtained using a transgenicmouse strain as described in Examples 8 and 9 and further describedbelow.

Antigens useful for producing anti-MASP-2 antibodies also include fusionpolypeptides, such as fusions of MASP-2 or a portion thereof with animmunoglobulin polypeptide or with maltose-binding protein. Thepolypeptide immunogen may be a full-length molecule or a portion thereofIf the polypeptide portion is hapten-like, such portion may beadvantageously joined or linked to a macromolecular carrier (such askeyhole limpet hemocyanin (KLH), bovine serum albumin (BSA) or tetanustoxoid) for immunization.

TABLE 2 MASP-2 DERIVED ANTIGENS SEQ ID NO: Amino Acid SequenceSEQ ID NO: 6 Human MASP-2 protein SEQ ID NO: 51 Murine MASP-2 proteinSEQ ID NO: 8 CUBI domain of human MASP-2 (aa 1-121 of SEQ ID NO: 6)SEQ ID NO: 9 CUBIEGF domains of human MASP-2 (aa 1-166 of SEQ ID NO: 6)SEQ ID NO: 10 CUBIEGFCUBII domains of human MASP-2(aa 1-293 of SEQ ID NO: 6) SEQ ID NO: 11 EGF domain of human MASP-2(aa 122-166 of SEQ ID NO: 6) SEQ ID NO: 12Serine-Protease domain of human MASP-2 (aa 429-671 of SEQ ID NO: 6)SEQ ID NO: 13 Serine-Protease inactivated mutant form GKDSCRGDAGGALVFL(aa 610-625 of SEQ ID NO: 6 with mutated Ser 618) SEQ ID NO: 14Human CUBI peptide TPLGPKWPEPVFGRL SEQ ID NO: 15: Human CUBI peptideTAPPGYRLRLYFTHFDLEL SHLCEYDFVKLSSGAKVL ATLCGQ SEQ ID NO: 16:MBL binding region in human CUBI domain TFRSDYSN SEQ ID NO: 17:MBL binding region in human CUBI domain FYSLGSSLDITFRSDYSNEK PFTGFSEQ ID NO: 18 EGF peptide IDECQVAPG SEQ ID NO: 19Peptide from serine-protease active site ANMLCAGLESGGKDSCRG DSGGALV

Polyclonal Antibodies

Polyclonal antibodies against MASP-2 can be prepared by immunizing ananimal with MASP-2 polypeptide or an immunogenic portion thereof usingmethods well known to those of ordinary skill in the art. See, forexample, Green et al., “Production of Polyclonal Antisera,” inImmunochemical Protocols (Manson, ed.), page 105, and as furtherdescribed in Example 6. The immunogenicity of a MASP-2 polypeptide canbe increased through the use of an adjuvant, including mineral gels,such as aluminum hydroxide or Freund's adjuvant (complete orincomplete), surface active substances such as lysolecithin, pluronicpolyols, polyanions, oil emulsions, keyhole limpet hemocyanin anddinitrophenol. Polyclonal antibodies are typically raised in animalssuch as horses, cows, dogs, chicken, rats, mice, rabbits, guinea pigs,goats, or sheep. Alternatively, an anti-MASP-2 antibody useful in thepresent invention may also be derived from a subhuman primate. Generaltechniques for raising diagnostically and therapeutically usefulantibodies in baboons may be found, for example, in Goldenberg et al.,International Patent Publication No. WO 91/11465, and in Losman, M. J.,et al., Int. J. Cancer 46:310, 1990. Sera containing immunologicallyactive antibodies are then produced from the blood of such immunizedanimals using standard procedures well known in the art.

Monoclonal Antibodies

In some embodiments, the MASP-2 inhibitory agent is an anti-MASP-2monoclonal antibody. Anti-MASP-2 monoclonal antibodies are highlyspecific, being directed against a single MASP-2 epitope. As usedherein, the modifier “monoclonal” indicates the character of theantibody as being obtained from a substantially homogenous population ofantibodies, and is not to be construed as requiring production of theantibody by any particular method. Monoclonal antibodies can be obtainedusing any technique that provides for the production of antibodymolecules by continuous cell lines in culture, such as the hybridomamethod described by Kohler, G., et al., Nature 256:495, 1975, or theymay be made by recombinant DNA methods (see, e.g., U.S. Pat. No.4,816,567 to Cabilly). Monoclonal antibodies may also be isolated fromphage antibody libraries using the techniques described in Clackson, T.,et al., Nature 352:624-628, 1991, and Marks, J. D., et al., J. Mol.Biol. 222:581-597, 1991. Such antibodies can be of any immunoglobulinclass including IgG, IgM, IgE, IgA, IgD and any subclass thereof.

For example, monoclonal antibodies can be obtained by injecting asuitable mammal (e.g., a BALB/c mouse) with a composition comprising aMASP-2 polypeptide or portion thereof. After a predetermined period oftime, splenocytes are removed from the mouse and suspended in a cellculture medium. The splenocytes are then fused with an immortal cellline to form a hybridoma. The formed hybridomas are grown in cellculture and screened for their ability to produce a monoclonal antibodyagainst MASP-2. An example further describing the production ofanti-MASP-2 monoclonal antibodies is provided in Example 7. (See alsoCurrent Protocols in Immunology, Vol. 1., John Wiley & Sons, pages2.5.1-2.6.7, 1991.)

Human monoclonal antibodies may be obtained through the use oftransgenic mice that have been engineered to produce specific humanantibodies in response to antigenic challenge. In this technique,elements of the human immunoglobulin heavy and light chain locus areintroduced into strains of mice derived from embryonic stem cell linesthat contain targeted disruptions of the endogenous immunoglobulin heavychain and light chain loci. The transgenic mice can synthesize humanantibodies specific for human antigens, such as the MASP-2 antigensdescribed herein, and the mice can be used to produce human MASP-2antibody-secreting hybridomas by fusing B-cells from such animals tosuitable myeloma cell lines using conventional Kohler-Milsteintechnology as further described in Example 7. Transgenic mice with ahuman immunoglobulin genome are commercially available (e.g., fromAbgenix, Inc., Fremont, CA, and Medarex, Inc., Annandale, N.J.). Methodsfor obtaining human antibodies from transgenic mice are described, forexample, by Green, L. L., et al., Nature Genet. 7:13, 1994; Lonberg, N.,et al., Nature 368:856, 1994; and Taylor, L. D., et al., Int. Immun.6:579, 1994.

Monoclonal antibodies can be isolated and purified from hybridomacultures by a variety of well-established techniques. Such isolationtechniques include affinity chromatography with Protein-A Sepharose,size-exclusion chromatography, and ion-exchange chromatography (see, forexample, Coligan at pages 2.7.1-2.7.12 and pages 2.9.1-2.9.3; Baines etal., “Purification of Immunoglobulin G (IgG),” in Methods in MolecularBiology, The Humana Press, Inc., Vol. 10, pages 79-104, 1992).

Once produced, polyclonal, monoclonal or phage-derived antibodies arefirst tested for specific MASP-2 binding. A variety of assays known tothose skilled in the art may be utilized to detect antibodies whichspecifically bind to MASP-2. Exemplary assays include Western blot orimmunoprecipitation analysis by standard methods (e.g., as described inAusubel et al.), immunoelectrophoresis, enzyme-linked immuno-sorbentassays, dot blots, inhibition or competition assays and sandwich assays(as described in Harlow and Land, Antibodies: A Laboratory Manual, ColdSpring Harbor Laboratory Press, 1988). Once antibodies are identifiedthat specifically bind to MASP-2, the anti-MASP-2 antibodies are testedfor the ability to function as a MASP-2 inhibitory agent in one ofseveral assays such as, for example, a lectin-specific C4 cleavage assay(described in Example 2), a C3b deposition assay (described in Example2) or a C4b deposition assay (described in Example 2).

The affinity of anti-MASP-2 monoclonal antibodies can be readilydetermined by one of ordinary skill in the art (see, e.g., Scatchard,A., NY Acad. Sci. 51:660-672, 1949). In one embodiment, the anti-MASP-2monoclonal antibodies useful for the methods of the invention bind toMASP-2 with a binding affinity of <100 nM, preferably <10 nM and mostpreferably <2 nM.

Chimeric/Humanized Antibodies

Monoclonal antibodies useful in the method of the invention includechimeric antibodies in which a portion of the heavy and/or light chainis identical with or homologous to corresponding sequences in antibodiesderived from a particular species or belonging to a particular antibodyclass or subclass, while the remainder of the chain(s) is identical withor homologous to corresponding sequences in antibodies derived fromanother species or belonging to another antibody class or subclass, aswell as fragments of such antibodies (U.S. Pat. No. 4,816,567, toCabilly; and Morrison, S. L., et al., Proc. Nat'l Acad. Sci. USA81:6851-6855, 1984).

One form of a chimeric antibody useful in the invention is a humanizedmonoclonal anti-MASP-2 antibody. Humanized forms of non-human (e.g.,murine) antibodies are chimeric antibodies, which contain minimalsequence derived from non-human immunoglobulin. Humanized monoclonalantibodies are produced by transferring the non-human (e.g., mouse)complementarity determining regions (CDR), from the heavy and lightvariable chains of the mouse immunoglobulin into a human variabledomain. Typically, residues of human antibodies are then substituted inthe framework regions of the non-human counterparts. Furthermore,humanized antibodies may comprise residues that are not found in therecipient antibody or in the donor antibody. These modifications aremade to further refine antibody performance. In general, the humanizedantibody will comprise substantially all of at least one, and typicallytwo variable domains, in which all or substantially all of thehypervariable loops correspond to those of a non-human immunoglobulinand all or substantially all of the Fv framework regions are those of ahuman immunoglobulin sequence. The humanized antibody optionally alsowill comprise at least a portion of an immunoglobulin constant region(Fc), typically that of a human immunoglobulin. For further details, seeJones, P. T., et al., Nature 321:522-525, 1986; Reichmann, L., et al.,Nature 332:323-329, 1988; and Presta, Curr. Op. Struct. Biol. 2:593-596,1992.

The humanized antibodies useful in the invention include humanmonoclonal antibodies including at least a MASP-2 binding CDR3 region.In addition, the Fc portions may be replaced so as to produce IgA or IgMas well as human IgG antibodies. Such humanized antibodies will haveparticular clinical utility because they will specifically recognizehuman MASP-2 but will not evoke an immune response in humans against theantibody itself. Consequently, they are better suited for in vivoadministration in humans, especially when repeated or long-termadministration is necessary.

An example of the generation of a humanized anti-MASP-2 antibody from amurine anti-MASP-2 monoclonal antibody is provided herein in Example 10.Techniques for producing humanized monoclonal antibodies are alsodescribed, for example, by Jones, P. T., et al., Nature 321:522, 1986;Carter, P., et al., Proc. Nat'l. Acad. Sci. USA 89:4285, 1992; Sandhu,J. S., Crit. Rev. Biotech. 12:437, 1992; Singer, et al., J. Immun.150:2844, 1993; Sudhir (ed.), Antibody Engineering Protocols, HumanaPress, Inc., 1995; Kelley, “Engineering Therapeutic Antibodies,” inProtein Engineering: Principles and Practice, Cleland et al. (eds.),John Wiley & Sons, Inc., pages 399-434, 1996; and by U.S. Pat. No.5,693,762, to Queen, 1997. In addition, there are commercial entitiesthat will synthesize humanized antibodies from specific murine antibodyregions, such as Protein Design Labs (Mountain View, Calif.).

Recombinant Antibodies

Anti-MASP-2 antibodies can also be made using recombinant methods. Forexample, human antibodies can be made using human immunoglobulinexpression libraries (available for example, from Stratagene, Corp., LaJolla, Calif.) to produce fragments of human antibodies (V_(H), V_(L),Fv, Fd, Fab or F(ab′)₂). These fragments are then used to constructwhole human antibodies using techniques similar to those for producingchimeric antibodies.

Anti-Idiotype Antibodies

Once anti-MASP-2 antibodies are identified with the desired inhibitoryactivity, these antibodies can be used to generate anti-idiotypeantibodies that resemble a portion of MASP-2 using techniques that arewell known in the art. See, e.g., Greenspan, N. S., et al., FASEB J.7:437, 1993. For example, antibodies that bind to MASP-2 andcompetitively inhibit a MASP-2 protein interaction required forcomplement activation can be used to generate anti-idiotypes thatresemble the MBL binding site on MASP-2 protein and therefore bind andneutralize a binding ligand of MASP-2 such as, for example, MBL.

Immunoglobulin Fragments

The MASP-2 inhibitory agents useful in the method of the inventionencompass not only intact immunoglobulin molecules but also the wellknown fragments including Fab, Fab′, F(ab)₂, F(ab′)₂ and Fv fragments,scFv fragments, diabodies, linear antibodies, single-chain antibodymolecules and multispecific antibodies formed from antibody fragments.

It is well known in the art that only a small portion of an antibodymolecule, the paratope, is involved in the binding of the antibody toits epitope (see, e.g., Clark, W. R., The Experimental Foundations ofModern Immunology, Wiley & Sons, Inc., NY, 1986). The pFc′ and Fcregions of the antibody are effectors of the classical complementpathway, but are not involved in antigen binding. An antibody from whichthe pFc′ region has been enzymatically cleaved, or which has beenproduced without the pFc′ region, is designated an F(ab′)₂ fragment andretains both of the antigen binding sites of an intact antibody. Anisolated F(ab′)₂ fragment is referred to as a bivalent monoclonalfragment because of its two antigen binding sites. Similarly, anantibody from which the Fc region has been enzymatically cleaved, orwhich has been produced without the Fc region, is designated a Fabfragment, and retains one of the antigen binding sites of an intactantibody molecule.

Antibody fragments can be obtained by proteolytic hydrolysis, such as bypepsin or papain digestion of whole antibodies by conventional methods.For example, antibody fragments can be produced by enzymatic cleavage ofantibodies with pepsin to provide a 5S fragment denoted F(ab′)₂. Thisfragment can be further cleaved using a thiol reducing agent to produce3.5S Fab′ monovalent fragments. Optionally, the cleavage reaction can beperformed using a blocking group for the sulfhydryl groups that resultfrom cleavage of disulfide linkages. As an alternative, an enzymaticcleavage using pepsin produces two monovalent Fab fragments and an Fcfragment directly. These methods are described, for example, U.S. Pat.No. 4,331,647 to Goldenberg; Nisonoff, A., et al., Arch. Biochem.Biophys. 89:230, 1960; Porter, R. R., Biochem. 1 73:119, 1959; Edelman,et al., in Methods in Enzymology 1:422, Academic Press, 1967; and byColigan at pages 2.8.1-2.8.10 and 2.10.-2.10.4.

In some embodiments, the use of antibody fragments lacking the Fc regionare preferred to avoid activation of the classical complement pathwaywhich is initiated upon binding Fc to the Fcγ receptor. There areseveral methods by which one can produce a MoAb that avoids Fcγ receptorinteractions. For example, the Fc region of a monoclonal antibody can beremoved chemically using partial digestion by proteolytic enzymes (suchas ficin digestion), thereby generating, for example, antigen-bindingantibody fragments such as Fab or F(ab)₂ fragments (Marian, M., et al.,Mol. Immunol. 28:69-71, 1991). Alternatively, the human γ4 IgG isotype,which does not bind Fcy receptors, can be used during construction of ahumanized antibody as described herein. Antibodies, single chainantibodies and antigen-binding domains that lack the Fc domain can alsobe engineered using recombinant techniques described herein.

Single-Chain Antibody Fragments

Alternatively, one can create single peptide chain binding moleculesspecific for MASP-2 in which the heavy and light chain Fv regions areconnected. The Fv fragments may be connected by a peptide linker to forma single-chain antigen binding protein (scFv). These single-chainantigen binding proteins are prepared by constructing a structural genecomprising DNA sequences encoding the V_(H) and V_(L) domains which areconnected by an oligonucleotide. The structural gene is inserted into anexpression vector, which is subsequently introduced into a host cell,such as E. coli. The recombinant host cells synthesize a singlepolypeptide chain with a linker peptide bridging the two V domains.Methods for producing scFvs are described for example, by Whitlow, etal., “Methods: A Companion to Methods in Enzymology” 2:97, 1991; Bird,et al., Science 242:423, 1988; U.S. Pat. No. 4,946,778, to Ladner; Pack,P., et al., Bio/Technology 11:1271, 1993.

As an illustrative example, a MASP-2 specific scFv can be obtained byexposing lymphocytes to MASP-2 polypeptide in vitro and selectingantibody display libraries in phage or similar vectors (for example,through the use of immobilized or labeled MASP-2 protein or peptide).Genes encoding polypeptides having potential MASP-2 polypeptide bindingdomains can be obtained by screening random peptide libraries displayedon phage or on bacteria such as E. coli. These random peptide displaylibraries can be used to screen for peptides which interact with MASP-2.Techniques for creating and screening such random peptide displaylibraries are well known in the art (U.S. Pat. No. 5,223,409, toLardner; U.S. Pat. No. 4,946,778, to Ladner; U.S. Pat. No. 5,403,484, toLardner; U.S. Pat. No. 5,571,698, to Lardner; and Kay et al., PhageDisplay of Peptides and Proteins Academic Press, Inc., 1996) and randompeptide display libraries and kits for screening such libraries areavailable commercially, for instance from CLONTECH Laboratories, Inc.(Palo Alto, Calif), Invitrogen Inc. (San Diego, Calif), New EnglandBiolabs, Inc. (Beverly, Mass.), and Pharmacia LKB Biotechnology Inc.(Piscataway, N.J.).

Another form of an anti-MASP-2 antibody fragment useful in this aspectof the invention is a peptide coding for a singlecomplementarity-determining region (CDR) that binds to an epitope on aMASP-2 antigen and inhibits MASP-2-dependent complement activation. CDRpeptides (“minimal recognition units”) can be obtained by constructinggenes encoding the CDR of an antibody of interest. Such genes areprepared, for example, by using the polymerase chain reaction tosynthesize the variable region from RNA of antibody-producing cells(see, for example, Larrick et al., Methods: A Companion to Methods inEnzymology 2:106, 1991; Courtenay-Luck, “Genetic Manipulation ofMonoclonal Antibodies,” in Monoclonal Antibodies: Production,Engineering and Clinical Application, Ritter et al. (eds.), page 166,Cambridge University Press, 1995; and Ward et al., “Genetic Manipulationand Expression of Antibodies,” in Monoclonal Antibodies: Principles andApplications, Birch et al. (eds.), page 137, Wiley-Liss, Inc., 1995).

The MASP-2 antibodies described herein are administered to a subject inneed thereof to inhibit MASP-2-dependent complement activation. In someembodiments, the MASP-2 inhibitory agent is a high-affinity human orhumanized monoclonal anti-MASP-2 antibody with reduced effectorfunction.

Peptide Inhibitors

In some embodiments of this aspect of the invention, the MASP-2inhibitory agent comprises isolated MASP-2 peptide inhibitors, includingisolated natural peptide inhibitors and synthetic peptide inhibitorsthat inhibit the MASP-2-dependent complement activation system. As usedherein, the term “isolated MASP-2 peptide inhibitors” refers to peptidesthat inhibit MASP-2 dependent complement activation by binding to,competing with MASP-2 for binding to another recognition molecule (e.g.,MBL, H-ficolin, M-ficolin, or L-ficolin) in the lectin pathway, and/ordirectly interacting with MASP-2 to inhibit MASP-2-dependent complementactivation that are substantially pure and are essentially free of othersubstances with which they may be found in nature to an extent practicaland appropriate for their intended use.

Peptide inhibitors have been used successfully in vivo to interfere withprotein-protein interactions and catalytic sites. For example, peptideinhibitors to adhesion molecules structurally related to LFA-1 haverecently been approved for clinical use in coagulopathies (Ohman, E. M.,et al., European Heart 1 16:50-55, 1995). Short linear peptides (<30amino acids) have been described that prevent or interfere withintegrin-dependent adhesion (Murayama, O., et al., J. Biochem.120:445-51, 1996). Longer peptides, ranging in length from 25 to 200amino acid residues, have also been used successfully to blockintegrin-dependent adhesion (Zhang, L., et al., J. Biol. Chem.271(47):29953-57, 1996). In general, longer peptide inhibitors havehigher affinities and/or slower off-rates than short peptides and maytherefore be more potent inhibitors. Cyclic peptide inhibitors have alsobeen shown to be effective inhibitors of integrins in vivo for thetreatment of human inflammatory disease (Jackson, D. Y., et al., J. Med.Chem. 40:3359-68, 1997). One method of producing cyclic peptidesinvolves the synthesis of peptides in which the terminal amino acids ofthe peptide are cysteines, thereby allowing the peptide to exist in acyclic form by disulfide bonding between the terminal amino acids, whichhas been shown to improve affinity and half-life in vivo for thetreatment of hematopoietic neoplasms (e.g., U.S. Pat. No. 6,649,592, toLarson).

Synthetic MASP-2 Peptide Inhibitors

MASP-2 inhibitory peptides useful in the methods of this aspect of theinvention are exemplified by amino acid sequences that mimic the targetregions important for MASP-2 function. The inhibitory peptides useful inthe practice of the methods of the invention range in size from about 5amino acids to about 300 amino acids. TABLE 3 provides a list ofexemplary inhibitory peptides that may be useful in the practice of thisaspect of the present invention. A candidate MASP-2 inhibitory peptidemay be tested for the ability to function as a MASP-2 inhibitory agentin one of several assays including, for example, a lectin specific C4cleavage assay (described in Example 2), and a C3b deposition assay(described in Example 2).

In some embodiments, the MASP-2 inhibitory peptides are derived fromMASP-2 polypeptides and are selected from the full length mature MASP-2protein (SEQ ID NO:6), or from a particular domain of the MASP-2 proteinsuch as, for example, the CUBI domain (SEQ ID NO:8), the CUBIEGF domain(SEQ ID NO:9), the EGF domain (SEQ ID NO:11), and the serine proteasedomain (SEQ ID NO:12). As previously described, the CUBEGFCUBII regionshave been shown to be required for dimerization and binding with MBL(Thielens et al., supra). In particular, the peptide sequence TFRSDYN(SEQ ID NO:16) in the CUBI domain of MASP-2 has been shown to beinvolved in binding to MBL in a study that identified a human carrying ahomozygous mutation at Asp105 to Gly105, resulting in the loss of MASP-2from the MBL complex (Stengaard-Pedersen, K., et al., New England J.Med. 349:554-560, 2003).

MASP-2 inhibitory peptides may also be derived from MAp19 (SEQ ID NO:3).As described in Example 30, MAp19 (SEQ ID NO:3) (also referred to assMAP), has the ability to down-regulate the lectin pathway, which isactivated by the MBL complex. Iwaki et al., J. Immunol. 177:8626-8632,2006. While not wishing to be bound by theory, it is likely that sMAP isable to occupy the MASP-2/sMAP binding site in MBL and prevent MASP-2from binding to MBL. It has also been reported that sMAP competes withMASP-2 in association with ficolin A and inhibits complement activationby the ficolin A/MASP-2 complex. Endo, Y., et al., Immunogenetics57:837-844 (2005).

In some embodiments, MASP-2 inhibitory peptides are derived from thelectin proteins that bind to MASP-2 and are involved in the lectincomplement pathway. Several different lectins have been identified thatare involved in this pathway, including mannan-binding lectin (MBL),L-ficolin, M-ficolin and H-ficolin. (Ikeda, K., et al., J. Biol. Chem.262:7451-7454, 1987; Matsushita, M., et al., J. Exp. Med. 176:1497-2284,2000; Matsushita, M., et al., J. Immunol. 168:3502-3506, 2002). Theselectins are present in serum as oligomers of homotrimeric subunits, eachhaving N-terminal collagen-like fibers with carbohydrate recognitiondomains. These different lectins have been shown to bind to MASP-2, andthe lectin/MASP-2 complex activates complement through cleavage ofproteins C4 and C2. H-ficolin has an amino-terminal region of 24 aminoacids, a collagen-like domain with 11 Gly-Xaa-Yaa repeats, a neck domainof 12 amino acids, and a fibrinogen-like domain of 207 amino acids(Matsushita, M., et al., J. Immunol. 168:3502-3506, 2002). H-ficolinbinds to GlcNAc and agglutinates human erythrocytes coated with LPSderived from S. typhimurium, S. minnesota and E. coli. H-ficolin hasbeen shown to be associated with MASP-2 and MAp19 and activates thelectin pathway. Id. L-ficolin/P35 also binds to GlcNAc and has beenshown to be associated with MASP-2 and MAp19 in human serum and thiscomplex has been shown to activate the lectin pathway (Matsushita, M.,et al., J. Immunol. 164:2281, 2000). Accordingly, MASP-2 inhibitorypeptides useful in the present invention may comprise a region of atleast 5 amino acids selected from the MBL protein (SEQ ID NO:21), theH-ficolin protein (Genbank accession number NM_173452), the M-ficolinprotein (Genbank accession number 000602) and the L-ficolin protein(Genbank accession number NM_015838).

More specifically, scientists have identified the MASP-2 binding site onMBL to be within the 12 Gly-X-Y triplets “GKD GRD GTK GEK GEP GQG LRGLQG POG KLG POG NOG PSG SOG PKG QKG DOG KS” (SEQ ID NO:26) that liebetween the hinge and the neck in the C-terminal portion of thecollagen-like domain of MBP (Wallis, R., et al., J. Biol. Chem.279:14065, 2004). This MASP-2 binding site region is also highlyconserved in human H-ficolin and human L-ficolin. A consensus bindingsite has been described that is present in all three lectin proteinscomprising the amino acid sequence “OGK-X-GP” (SEQ ID NO:22) where theletter “0” represents hydroxyproline and the letter “X” is a hydrophobicresidue (Wallis et al., 2004, supra). Accordingly, in some embodiments,MASP-2 inhibitory peptides useful in this aspect of the invention are atleast 6 amino acids in length and comprise SEQ ID NO:22. Peptidesderived from MBL that include the amino acid sequence “GLR GLQ GPO GKLGPO G” (SEQ ID NO:24) have been shown to bind MASP-2 in vitro (Wallis,et al., 2004, supra). To enhance binding to MASP-2, peptides can besynthesized that are flanked by two GPO triplets at each end (“GPO GPOGLR GLQ GPO GKL GPO GGP OGP 0” SEQ ID NO:25) to enhance the formation oftriple helices as found in the native MBL protein (as further describedin Wallis, R., et al., J. Biol. Chem. 279:14065, 2004).

MASP-2 inhibitory peptides may also be derived from human H-ficolin thatinclude the sequence “GAO GSO GEK GAO GPQ GPO GPO GKM GPK GEO GDO” (SEQID NO:27) from the consensus MASP-2 binding region in H-ficolin. Alsoincluded are peptides derived from human L-ficolin that include thesequence “GCO GLO GAO GDK GEA GTN GKR GER GPO GPO GKA GPO GPN GAO GEO”(SEQ ID NO:28) from the consensus MASP-2 binding region in L-ficolin.

MASP-2 inhibitory peptides may also be derived from the C4 cleavage sitesuch as “LQRALEILPNRVTIKANRPFLVFI” (SEQ ID NO:29) which is the C4cleavage site linked to the C-terminal portion of antithrombin III(Glover, G. I., et al., Mol. Immunol. 25:1261 (1988)).

TABLE 3 EXEMPLARY MASP-2 INHIBITORY PEPTIDES SEQ ID NO SourceSEQ ID NO: 6 Human MASP-2 protein SEQ ID NO: 8CUBI domain of MASP-2 (aa 1-121 of SEQ ID NO: 6) SEQ ID NO: 9CUBIEGF domains of MASP-2 (aa 1-166 of SEQ ID NO: 6) SEQ ID NO: 10CUBIEGFCUBII domains of MASP-2 (aa 1-293 of SEQ ID NO: 6) SEQ ID NO: 11EGF domain of MASP-2 (aa 122-166) SEQ ID NO: 12Serine-protease domain of MASP-2 (aa 429-671) SEQ ID NO: 16MBL binding region in MASP-2 SEQ ID NO: 3 Human MAp19 SEQ ID NO: 21Human MBL protein SEQ ID NO: 22Synthetic peptide Consensus binding site from Human OGK-X-GP,MBL and Human ficolins Where ″O″ = hydroxyproline and ″X″is a hydrophobic amino acid residue SEQ ID NO: 23Human MBL core binding site OGKLG SEQ ID NO: 24Human MBP Triplets 6-10- demonstrated binding to GLR GLQ GPO GKL MASP-2GPO G SEQ ID NO: 25 Human MBP Triplets with GPO added to enhanceGPOGPOGLRGLQGPO formation of triple helices GKLGPOGGPOGPO SEQ ID NO: 26Human MBP Triplets 1-17 GKDGRDGTKGEKGEP GQGLRGLQGPOGKLG POGNOGPSGSOGPKGQKGDOGKS SEQ ID NO: 27 Human H-Ficolin (Hataka) GAOGSOGEKGAOGPQGPOGPOGKMGPKGEO GDO SEQ ID NO: 28 Human L-Ficolin P35 GCOGLOGAOGDKGEAGTNGKRGERGPOGP OGKAGPOGPNGAOGE O SEQ ID NO: 29 Human C4 cleavage siteLQRALEILPNRVTIKA NRPFLVFI Note: The letter ″O″ representshydroxyproline. The letter ″X″ is a hydrophobic residue.

Peptides derived from the C4 cleavage site as well as other peptidesthat inhibit the MASP-2 serine protease site can be chemically modifiedso that they are irreversible protease inhibitors. For example,appropriate modifications may include, but are not necessarily limitedto, halomethyl ketones (Br, Cl, I, F) at the C-terminus, Asp or Glu, orappended to functional side chains; haloacetyl (or other a-haloacetyl)groups on amino groups or other functional side chains; epoxide orimine-containing groups on the amino or carboxy termini or on functionalside chains; or imidate esters on the amino or carboxy termini or onfunctional side chains. Such modifications would afford the advantage ofpermanently inhibiting the enzyme by covalent attachment of the peptide.This could result in lower effective doses and/or the need for lessfrequent administration of the peptide inhibitor.

In addition to the inhibitory peptides described above, MASP-2inhibitory peptides useful in the method of the invention includepeptides containing the MASP-2-binding CDR3 region of anti-MASP-2 MoAbobtained as described herein. The sequence of the CDR regions for use insynthesizing the peptides may be determined by methods known in the art.The heavy chain variable region is a peptide that generally ranges from100 to 150 amino acids in length. The light chain variable region is apeptide that generally ranges from 80 to 130 amino acids in length. TheCDR sequences within the heavy and light chain variable regions includeonly approximately 3-25 amino acid sequences that may be easilysequenced by one of ordinary skill in the art.

Those skilled in the art will recognize that substantially homologousvariations of the MASP-2 inhibitory peptides described above will alsoexhibit MASP-2 inhibitory activity. Exemplary variations include, butare not necessarily limited to, peptides having insertions, deletions,replacements, and/or additional amino acids on the carboxy-terminus oramino-terminus portions of the subject peptides and mixtures thereof.Accordingly, those homologous peptides having MASP-2 inhibitory activityare considered to be useful in the methods of this invention. Thepeptides described may also include duplicating motifs and othermodifications with conservative substitutions. Conservative variants aredescribed elsewhere herein, and include the exchange of an amino acidfor another of like charge, size or hydrophobicity and the like.

MASP-2 inhibitory peptides may be modified to increase solubility and/orto maximize the positive or negative charge in order to more closelyresemble the segment in the intact protein. The derivative may or maynot have the exact primary amino acid structure of a peptide disclosedherein so long as the derivative functionally retains the desiredproperty of MASP-2 inhibition. The modifications can include amino acidsubstitution with one of the commonly known twenty amino acids or withanother amino acid, with a derivatized or substituted amino acid withancillary desirable characteristics, such as resistance to enzymaticdegradation or with a D-amino acid or substitution with another moleculeor compound, such as a carbohydrate, which mimics the naturalconfirmation and function of the amino acid, amino acids or peptide;amino acid deletion; amino acid insertion with one of the commonly knowntwenty amino acids or with another amino acid, with a derivatized orsubstituted amino acid with ancillary desirable characteristics, such asresistance to enzymatic degradation or with a D-amino acid orsubstitution with another molecule or compound, such as a carbohydrate,which mimics the natural confirmation and function of the amino acid,amino acids or peptide; or substitution with another molecule orcompound, such as a carbohydrate or nucleic acid monomer, which mimicsthe natural conformation, charge distribution and function of the parentpeptide. Peptides may also be modified by acetylation or amidation.

The synthesis of derivative inhibitory peptides can rely on knowntechniques of peptide biosynthesis, carbohydrate biosynthesis and thelike. As a starting point, the artisan may rely on a suitable computerprogram to determine the conformation of a peptide of interest. Once theconformation of peptide disclosed herein is known, then the artisan candetermine in a rational design fashion what sort of substitutions can bemade at one or more sites to fashion a derivative that retains the basicconformation and charge distribution of the parent peptide but which maypossess characteristics which are not present or are enhanced over thosefound in the parent peptide. Once candidate derivative molecules areidentified, the derivatives can be tested to determine if they functionas MASP-2 inhibitory agents using the assays described herein.

Screening for MASP-2 Inhibitory Peptides

One may also use molecular modeling and rational molecular design togenerate and screen for peptides that mimic the molecular structures ofkey binding regions of MASP-2 and inhibit the complement activities ofMASP-2. The molecular structures used for modeling include the CDRregions of anti-MASP-2 monoclonal antibodies, as well as the targetregions known to be important for MASP-2 function including the regionrequired for dimerization, the region involved in binding to MBL, andthe serine protease active site as previously described. Methods foridentifying peptides that bind to a particular target are well known inthe art. For example, molecular imprinting may be used for the de novoconstruction of macromolecular structures such as peptides that bind toa particular molecule. See, for example, Shea, K. J., “MolecularImprinting of Synthetic Network Polymers: The De Novo synthesis ofMacromolecular Binding and Catalytic Sties,” TRIP 2(5) 1994.

As an illustrative example, one method of preparing mimics of MASP-2binding peptides is as follows. Functional monomers of a known MASP-2binding peptide or the binding region of an anti-MASP-2 antibody thatexhibits MASP-2 inhibition (the template) are polymerized. The templateis then removed, followed by polymerization of a second class ofmonomers in the void left by the template, to provide a new moleculethat exhibits one or more desired properties that are similar to thetemplate. In addition to preparing peptides in this manner, other MASP-2binding molecules that are MASP-2 inhibitory agents such aspolysaccharides, nucleosides, drugs, nucleoproteins, lipoproteins,carbohydrates, glycoproteins, steroid, lipids and other biologicallyactive materials can also be prepared. This method is useful fordesigning a wide variety of biological mimics that are more stable thantheir natural counterparts because they are typically prepared by freeradical polymerization of function monomers, resulting in a compoundwith a nonbiodegradable backbone.

Peptide Synthesis

The MASP-2 inhibitory peptides can be prepared using techniques wellknown in the art, such as the solid-phase synthetic technique initiallydescribed by Merrifield, in J. Amer. Chem. Soc. 85:2149-2154, 1963.Automated synthesis may be achieved, for example, using AppliedBiosystems 431A Peptide Synthesizer (Foster City, Calif.) in accordancewith the instructions provided by the manufacturer. Other techniques maybe found, for example, in Bodanszky, M., et al., Peptide Synthesis,second edition, John Wiley & Sons, 1976, as well as in other referenceworks known to those skilled in the art.

The peptides can also be prepared using standard genetic engineeringtechniques known to those skilled in the art. For example, the peptidecan be produced enzymatically by inserting nucleic acid encoding thepeptide into an expression vector, expressing the DNA, and translatingthe DNA into the peptide in the presence of the required amino acids.The peptide is then purified using chromatographic or electrophoretictechniques, or by means of a carrier protein that can be fused to, andsubsequently cleaved from, the peptide by inserting into the expressionvector in phase with the peptide encoding sequence a nucleic acidsequence encoding the carrier protein. The fusion protein-peptide may beisolated using chromatographic, electrophoretic or immunologicaltechniques (such as binding to a resin via an antibody to the carrierprotein). The peptide can be cleaved using chemical methodology orenzymatically, as by, for example, hydrolases.

The MASP-2 inhibitory peptides that are useful in the method of theinvention can also be produced in recombinant host cells followingconventional techniques. To express a MASP-2 inhibitory peptide encodingsequence, a nucleic acid molecule encoding the peptide must be operablylinked to regulatory sequences that control transcriptional expressionin an expression vector and then introduced into a host cell. Inaddition to transcriptional regulatory sequences, such as promoters andenhancers, expression vectors can include translational regulatorysequences and a marker gene, which are suitable for selection of cellsthat carry the expression vector.

Nucleic acid molecules that encode a MASP-2 inhibitory peptide can besynthesized with “gene machines” using protocols such as thephosphoramidite method. If chemically synthesized double-stranded DNA isrequired for an application such as the synthesis of a gene or a genefragment, then each complementary strand is made separately. Theproduction of short genes (60 to 80 base pairs) is technicallystraightforward and can be accomplished by synthesizing thecomplementary strands and then annealing them. For the production oflonger genes, synthetic genes (double-stranded) are assembled in modularform from single-stranded fragments that are from 20 to 100 nucleotidesin length. For reviews on polynucleotide synthesis, see, for example,Glick and Pasternak, “Molecular Biotechnology, Principles andApplications of Recombinant DNA”, ASM Press, 1994; Itakura, K., et al.,Annu. Rev. Biochem. 53:323, 1984; and Climie, S., et al., Proc. Nat'lAcad. Sci. USA 87:633, 1990.

Small Molecule Inhibitors

In some embodiments, MASP-2 inhibitory agents are small moleculeinhibitors including natural and synthetic substances that have a lowmolecular weight, such as for example, peptides, peptidomimetics andnonpeptide inhibitors (including oligonucleotides and organiccompounds). Small molecule inhibitors of MASP-2 can be generated basedon the molecular structure of the variable regions of the anti-MASP-2antibodies.

Small molecule inhibitors may also be designed and generated based onthe MASP-2 crystal structure using computational drug design (Kuntz I.D., et al., Science 257:1078, 1992). The crystal structure of rat MASP-2has been described (Feinberg, H., et al., EMBO J. 22:2348-2359, 2003).Using the method described by Kuntz et al., the MASP-2 crystal structurecoordinates are used as an input for a computer program such as DOCK,which outputs a list of small molecule structures that are expected tobind to MASP-2. Use of such computer programs is well known to one ofskill in the art. For example, the crystal structure of the HIV-1protease inhibitor was used to identify unique nonpeptide ligands thatare HIV-1 protease inhibitors by evaluating the fit of compounds foundin the Cambridge Crystallographic database to the binding site of theenzyme using the program DOCK (Kuntz, I. D., et al., J. Mol. Biol.161:269-288, 1982; DesJarlais, R. L., et al., PNAS 87:6644-6648, 1990).

The list of small molecule structures that are identified by acomputational method as potential MASP-2 inhibitors are screened using aMASP-2 binding assay such as described in Example 7. The small moleculesthat are found to bind to MASP-2 are then assayed in a functional assaysuch as described in Example 2 to determine if they inhibitMASP-2-dependent complement activation.

MASP-2 Soluble Receptors

Other suitable MASP-2 inhibitory agents are believed to include MASP-2soluble receptors, which may be produced using techniques known to thoseof ordinary skill in the art.

Expression Inhibitors of MASP-2

In another embodiment of this aspect of the invention, the MASP-2inhibitory agent is a MASP-2 expression inhibitor capable of inhibitingMASP-2-dependent complement activation. In the practice of this aspectof the invention, representative MASP-2 expression inhibitors includeMASP-2 antisense nucleic acid molecules (such as antisense mRNA,antisense DNA or antisense oligonucleotides), MASP-2 ribozymes andMASP-2 RNAi molecules.

Anti-sense RNA and DNA molecules act to directly block the translationof MASP-2 mRNA by hybridizing to MASP-2 mRNA and preventing translationof MASP-2 protein. An antisense nucleic acid molecule may be constructedin a number of different ways provided that it is capable of interferingwith the expression of MASP-2. For example, an antisense nucleic acidmolecule can be constructed by inverting the coding region (or a portionthereof) of MASP-2 cDNA (SEQ ID NO:4) relative to its normal orientationfor transcription to allow for the transcription of its complement.

The antisense nucleic acid molecule is usually substantially identicalto at least a portion of the target gene or genes. The nucleic acid,however, need not be perfectly identical to inhibit expression.Generally, higher homology can be used to compensate for the use of ashorter antisense nucleic acid molecule. The minimal percent identity istypically greater than about 65%, but a higher percent identity mayexert a more effective repression of expression of the endogenoussequence. Substantially greater percent identity of more than about 80%typically is preferred, though about 95% to absolute identity istypically most preferred.

The antisense nucleic acid molecule need not have the same intron orexon pattern as the target gene, and non-coding segments of the targetgene may be equally effective in achieving antisense suppression oftarget gene expression as coding segments. A DNA sequence of at leastabout 8 or so nucleotides may be used as the antisense nucleic acidmolecule, although a longer sequence is preferable. In the presentinvention, a representative example of a useful inhibitory agent ofMASP-2 is an antisense MASP-2 nucleic acid molecule which is at leastninety percent identical to the complement of the MASP-2 cDNA consistingof the nucleic acid sequence set forth in SEQ ID NO:4. The nucleic acidsequence set forth in SEQ ID NO:4 encodes the MASP-2 protein consistingof the amino acid sequence set forth in SEQ ID NO:5.

The targeting of antisense oligonucleotides to bind MASP-2 mRNA isanother mechanism that may be used to reduce the level of MASP-2 proteinsynthesis. For example, the synthesis of polygalacturonase and themuscarine type 2 acetylcholine receptor is inhibited by antisenseoligonucleotides directed to their respective mRNA sequences (U.S. Pat.No. 5,739,119, to Cheng, and U.S. Pat. No. 5,759,829, to Shewmaker).Furthermore, examples of antisense inhibition have been demonstratedwith the nuclear protein cyclin, the multiple drug resistance gene(MDG1), ICAM-1, E-selectin, STK-1, striatal GABA_(A) receptor and humanEGF (see, e.g., U.S. Pat. No. 5,801,154, to Baracchini; U.S. Pat. No.5,789,573, to Baker; U.S. Pat. No. 5,718,709, to Considine; and U.S.Pat. No. 5,610,288, to Reubenstein).

A system has been described that allows one of ordinary skill todetermine which oligonucleotides are useful in the invention, whichinvolves probing for suitable sites in the target mRNA using Rnase Hcleavage as an indicator for accessibility of sequences within thetranscripts. Scherr, M., et al., Nucleic Acids Res. 26:5079-5085, 1998;Lloyd, et al., Nucleic Acids Res. 29:3665-3673, 2001. A mixture ofantisense oligonucleotides that are complementary to certain regions ofthe MASP-2 transcript is added to cell extracts expressing MASP-2, suchas hepatocytes, and hybridized in order to create an RNAseH vulnerablesite. This method can be combined with computer-assisted sequenceselection that can predict optimal sequence selection for antisensecompositions based upon their relative ability to form dimers, hairpins,or other secondary structures that would reduce or prohibit specificbinding to the target mRNA in a host cell. These secondary structureanalysis and target site selection considerations may be performed usingthe OLIGO primer analysis software (Rychlik, I., 1997) and the BLASTN2.0.5 algorithm software (Altschul, S. F., et al., Nucl. Acids Res.25:3389-3402, 1997). The antisense compounds directed towards the targetsequence preferably comprise from about 8 to about 50 nucleotides inlength. Antisense oligonucleotides comprising from about 9 to about 35or so nucleotides are particularly preferred. The inventors contemplateall oligonucleotide compositions in the range of 9 to 35 nucleotides(i.e., those of 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22,23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, or 35 or so bases inlength) are highly preferred for the practice of antisenseoligonucleotide-based methods of the invention. Highly preferred targetregions of the MASP-2 mRNA are those that are at or near the AUGtranslation initiation codon, and those sequences that are substantiallycomplementary to 5′ regions of the mRNA, e.g., between the −10 and +10regions of the MASP-2 gene nucleotide sequence (SEQ ID NO:4). ExemplaryMASP-2 expression inhibitors are provided in TABLE 4.

TABLE 4 EXEMPLARY EXPRESSION INHIBITORS OF MASP-2SEQ ID NO: 30 (nucleotides Nucleic acid sequence of MASP-2 cDNA22-680 of SEQ ID NO: 4) (SEQ ID NO: 4) encoding CUBIEGF SEQ ID NO: 31Nucleotides 12-45 of SEQ ID NO: 4 5′CGGGCACACCATGAGGCTGCTGincluding the MASP-2 translation start site ACCCTCCTGGGC3 (sense)SEQ ID NO: 32 Nucleotides 361-396 of SEQ ID NO: 45′GACATTACCTTCCGCTCCGACTC encoding a region comprising the MASP-2CAACGAGAAG3′ MBL binding site (sense) SEQ ID NO: 33Nucleotides 610-642 of SEQ ID NO: 4 5′AGCAGCCCTGAATACCCACGGCCencoding a region comprising the CUBII GTATCCCAAA3′ domain

As noted above, the term “oligonucleotide” as used herein refers to anoligomer or polymer of ribonucleic acid (RNA) or deoxyribonucleic acid(DNA) or mimetics thereof. This term also covers those oligonucleobasescomposed of naturally occurring nucleotides, sugars and covalentinternucleoside (backbone) linkages as well as oligonucleotides havingnon-naturally occurring modifications. These modifications allow one tointroduce certain desirable properties that are not offered throughnaturally occurring oligonucleotides, such as reduced toxic properties,increased stability against nuclease degradation and enhanced cellularuptake. In illustrative embodiments, the antisense compounds of theinvention differ from native DNA by the modification of thephosphodiester backbone to extend the life of the antisenseoligonucleotide in which the phosphate substituents are replaced byphosphorothioates. Likewise, one or both ends of the oligonucleotide maybe substituted by one or more acridine derivatives that intercalatebetween adjacent basepairs within a strand of nucleic acid.

Another alternative to antisense is the use of “RNA interference”(RNAi). Double-stranded RNAs (dsRNAs) can provoke gene silencing inmammals in vivo. The natural function of RNAi and co-suppression appearsto be protection of the genome against invasion by mobile geneticelements such as retrotransposons and viruses that produce aberrant RNAor dsRNA in the host cell when they become active (see, e.g., Jensen,J., et al., Nat. Genet. 21:209-12, 1999). The double-stranded RNAmolecule may be prepared by synthesizing two RNA strands capable offorming a double-stranded RNA molecule, each having a length from about19 to 25 (e.g., 19-23 nucleotides). For example, a dsRNA molecule usefulin the methods of the invention may comprise the RNA corresponding to asequence and its complement listed in TABLE 4. Preferably, at least onestrand of RNA has a 3′ overhang from 1-5 nucleotides. The synthesizedRNA strands are combined under conditions that form a double-strandedmolecule. The RNA sequence may comprise at least an 8 nucleotide portionof SEQ ID NO:4 with a total length of 25 nucleotides or less. The designof siRNA sequences for a given target is within the ordinary skill ofone in the art. Commercial services are available that design siRNAsequence and guarantee at least 70% knockdown of expression (Qiagen,Valencia, Calif).

The dsRNA may be administered as a pharmaceutical composition andcarried out by known methods, wherein a nucleic acid is introduced intoa desired target cell. Commonly used gene transfer methods includecalcium phosphate, DEAE-dextran, electroporation, microinjection andviral methods. Such methods are taught in Ausubel et al., CurrentProtocols in Molecular Biology, ohn Wiley & Sons, Inc., 1993.

Ribozymes can also be utilized to decrease the amount and/or biologicalactivity of MASP-2, such as ribozymes that target MASP-2 mRNA. Ribozymesare catalytic RNA molecules that can cleave nucleic acid moleculeshaving a sequence that is completely or partially homologous to thesequence of the ribozyme. It is possible to design ribozyme transgenesthat encode RNA ribozymes that specifically pair with a target RNA andcleave the phosphodiester backbone at a specific location, therebyfunctionally inactivating the target RNA. In carrying out this cleavage,the ribozyme is not itself altered, and is thus capable of recycling andcleaving other molecules. The inclusion of ribozyme sequences withinantisense RNAs confers RNA-cleaving activity upon them, therebyincreasing the activity of the antisense constructs.

Ribozymes useful in the practice of the invention typically comprise ahybridizing region of at least about nine nucleotides, which iscomplementary in nucleotide sequence to at least part of the targetMASP-2 mRNA, and a catalytic region that is adapted to cleave the targetMASP-2 mRNA (see generally, EPA No. 0 321 201; WO88/04300; Haseloff, J.,et al., Nature 334:585-591, 1988; Fedor, M. J., et al., Proc. Natl.Acad. Sci. USA 87:1668-1672, 1990; Cech, T. R., et al., Ann. Rev.Biochem. 55:599-629, 1986).

Ribozymes can either be targeted directly to cells in the form of RNAoligonucleotides incorporating ribozyme sequences, or introduced intothe cell as an expression vector encoding the desired ribozymal RNA.Ribozymes may be used and applied in much the same way as described forantisense polynucleotides.

Anti-sense RNA and DNA, ribozymes and RNAi molecules useful in themethods of the invention may be prepared by any method known in the artfor the synthesis of DNA and RNA molecules. These include techniques forchemically synthesizing oligodeoxyribonucleotides andoligoribonucleotides well known in the art, such as for example solidphase phosphoramidite chemical synthesis. Alternatively, RNA moleculesmay be generated by in vitro and in vivo transcription of DNA sequencesencoding the antisense RNA molecule. Such DNA sequences may beincorporated into a wide variety of vectors that incorporate suitableRNA polymerase promoters such as the T7 or SP6 polymerase promoters.Alternatively, antisense cDNA constructs that synthesize antisense RNAconstitutively or inducibly, depending on the promoter used, can beintroduced stably into cell lines.

Various well known modifications of the DNA molecules may be introducedas a means of increasing stability and half-life. Useful modificationsinclude, but are not limited to, the addition of flanking sequences ofribonucleotides or deoxyribonucleotides to the 5′ and/or 3′ ends of themolecule or the use of phosphorothioate or 2′ O-methyl rather thanphosphodiesterase linkages within the oligodeoxyribonucleotide backbone.

V. PHARMACEUTICAL COMPOSITIONS AND DELIVERY METHODS DOSING

In another aspect, the invention provides compositions for inhibitingthe adverse effects of MASP-2-dependent complement activation comprisinga therapeutically effective amount of a MASP-2 inhibitory agent and apharmaceutically acceptable carrier. The MASP-2 inhibitory agents can beadministered to a subject in need thereof, at therapeutically effectivedoses to treat or ameliorate conditions associated with MASP-2-dependentcomplement activation. A therapeutically effective dose refers to theamount of the MASP-2 inhibitory agent sufficient to result inamelioration of symptoms of the condition.

Toxicity and therapeutic efficacy of MASP-2 inhibitory agents can bedetermined by standard pharmaceutical procedures employing experimentalanimal models, such as the murine MASP-2 −/− mouse model expressing thehuman MASP-2 transgene described in Example 3. Using such animal models,the NOAEL (no observed adverse effect level) and the MED (the minimallyeffective dose) can be determined using standard methods. The dose ratiobetween NOAEL and MED effects is the therapeutic ratio, which isexpressed as the ratio NOAEL/MED MASP-2 inhibitory agents that exhibitlarge therapeutic ratios or indices are most preferred. The dataobtained from the cell culture assays and animal studies can be used informulating a range of dosages for use in humans. The dosage of theMASP-2 inhibitory agent preferably lies within a range of circulatingconcentrations that include the MED with little or no toxicity. Thedosage may vary within this range depending upon the dosage formemployed and the route of administration utilized.

For any compound formulation, the therapeutically effective dose can beestimated using animal models. For example, a dose may be formulated inan animal model to achieve a circulating plasma concentration range thatincludes the MED Quantitative levels of the MASP-2 inhibitory agent inplasma may also be measured, for example, by high performance liquidchromatography.

In addition to toxicity studies, effective dosage may also be estimatedbased on the amount of MASP-2 protein present in a living subject andthe binding affinity of the MASP-2 inhibitory agent. It has been shownthat MASP-2 levels in normal human subjects is present in serum in lowlevels in the range of 500 ng/ml, and MASP-2 levels in a particularsubject can be determined using a quantitative assay for MASP-2described in Moller-Kristensen M., et al., J. Immunol. Methods282:159-167, 2003.

Generally, the dosage of administered compositions comprising MASP-2inhibitory agents varies depending on such factors as the subject's age,weight, height, sex, general medical condition, and previous medicalhistory. As an illustration, MASP-2 inhibitory agents, such asanti-MASP-2 antibodies, can be administered in dosage ranges from about0.010 to 10.0 mg/kg, preferably 0.010 to 1.0 mg/kg, more preferably0.010 to 0.1 mg/kg of the subject body weight. In some embodiments thecomposition comprises a combination of anti-MASP-2 antibodies and MASP-2inhibitory peptides.

Therapeutic efficacy of MASP-2 inhibitory compositions and methods ofthe present invention in a given subject, and appropriate dosages, canbe determined in accordance with complement assays well known to thoseof skill in the art. Complement generates numerous specific products.During the last decade, sensitive and specific assays have beendeveloped and are available commercially for most of these activationproducts, including the small activation fragments C3a, C4a, and C5a andthe large activation fragments iC3b, C4d, Bb, and sC5b-9. Most of theseassays utilize monoclonal antibodies that react with new antigens(neoantigens) exposed on the fragment, but not on the native proteinsfrom which they are formed, making these assays very simple andspecific. Most rely on ELISA technology, although radioimmunoassay isstill sometimes used for C3a and C5a. These latter assays measure boththe unprocessed fragments and their ‘desArg’ fragments, which are themajor forms found in the circulation. Unprocessed fragments and_(CSadesArg) are rapidly cleared by binding to cell surface receptorsand are hence present in very low concentrations, whereas C3a_(desArg)does not bind to cells and accumulates in plasma. Measurement of C3aprovides a sensitive, pathway-independent indicator of complementactivation. Alternative pathway activation can be assessed by measuringthe Bb fragment. Detection of the fluid-phase product of membrane attackpathway activation, sC5b-9, provides evidence that complement is beingactivated to completion. Because both the lectin and classical pathwaysgenerate the same activation products, C4a and C4d, measurement of thesetwo fragments does not provide any information about which of these twopathways has generated the activation products.

Additional Agents

The compositions and methods comprising MASP-2 inhibitory agents mayoptionally comprise one or more additional therapeutic agents, which mayaugment the activity of the MASP-2 inhibitory agent or that providerelated therapeutic functions in an additive or synergistic fashion. Forexample, one or more MASP-2 inhibitory agents may be administered incombination with one or more anti-inflammatory and/or analgesic agents.The inclusion and selection of additional agent(s) will be determined toachieve a desired therapeutic result. Suitable anti-inflammatory and/oranalgesic agents include: serotonin receptor antagonists; serotoninreceptor agonists; histamine receptor antagonists; bradykinin receptorantagonists; kallikrein inhibitors; tachykinin receptor antagonists,including neurokinin₁ and neurokinin receptor subtype antagonists;calcitonin gene-related peptide (CGRP) receptor antagonists; interleukinreceptor antagonists; inhibitors of enzymes active in the syntheticpathway for arachidonic acid metabolites, including phospholipaseinhibitors, including PLA₂ isoform inhibitors and PLC_(γ) isoforminhibitors, cyclooxygenase (COX) inhibitors (which may be either COX-1,COX-2, or nonselective COX-1 and -2 inhibitors), lipooxygenaseinhibitors; prostanoid receptor antagonists including eicosanoid EP-1and EP-4 receptor subtype antagonists and thromboxane receptor subtypeantagonists; leukotriene receptor antagonists including leukotriene B₄receptor subtype antagonists and leukotriene D₄ receptor subtypeantagonists; opioid receptor agonists, including μ-opioid, δ-opioid, andκ-opioid receptor subtype agonists; purinoceptor agonists andantagonists including P_(2X) receptor antagonists and P_(2Y) receptoragonists; adenosine triphosphate (ATP)-sensitive potassium channelopeners; MAP kinase inhibitors; nicotinic acetylcholine inhibitors; andalpha adrenergic receptor agonists (including alpha-1, alpha-2, andnonselective alpha-1 and 2 agonists).

When used in the prevention or treatment of restenosis, the MASP-2inhibitory agent of the present invention may be combined with one ormore anti-restenosis agents for concomitant administration. Suitableanti-restenosis agents include: antiplatelet agents including: thrombininhibitors and receptor antagonists, adenosine diphosphate (ADP)receptor antagonists (also known as purinoceptor₁ receptor antagonists),thromboxane inhibitors and receptor antagonists and platelet membraneglycoprotein receptor antagonists; inhibitors of cell adhesionmolecules, including selectin inhibitors and integrin inhibitors;anti-chemotactic agents; interleukin receptor antagonists; andintracellular signaling inhibitors including: protein kinase C (PKC)inhibitors and protein tyrosine phosphatases, modulators ofintracellular protein tyrosine kinase inhibitors, inhibitors of srchomology (SH2) domains, and calcium channel antagonists.

The MASP-2 inhibitory agents of the present invention may also beadministered in combination with one or more other complementinhibitors. No complement inhibitors are currently approved for use inhumans, however some pharmacological agents have been shown to blockcomplement in vivo. Many of these agents are also toxic or are onlypartial inhibitors (Asghar, S. S., Pharmacol. Rev. 36:223-44, 1984), anduse of these has been limited to use as research tools. K76COOH andnafamstat mesilate are two agents that have shown some effectiveness inanimal models of transplantation (Miyagawa, S., et al., Transplant Proc.24:483-484, 1992). Low molecular weight heparins have also been shown tobe effective in regulating complement activity (Edens, R. E., et al.,Complement Today, pp. 96-120, Basel: Karger, 1993). It is believed thatthese small molecule inhibitors may be useful as agents to use incombination with the MASP-2 inhibitory agents of the present invention.Other naturally occurring complement inhibitors may be useful incombination with the MASP-2 inhibitory agents of the present invention.Biological inhibitors of complement include soluble complement factor 1(sCR1). This is a naturally-occurring inhibitor that can be found on theouter membrane of human cells. Other membrane inhibitors include DAF,MCP, and CD59. Recombinant forms have been tested for theiranti-complement activity in vitro and in vivo. sCR1 has been shown to beeffective in xenotransplantation, wherein the complement system (bothalternative and classical) provides the trigger for a hyperactiverejection syndrome within minutes of perfusing blood through the newlytransplanted organ (Platt, J. L , et al., Immunol. Today 11:450-6, 1990;Marino, I. R., et al., Transplant Proc. 1071:6, 1990; Johnstone, P. S.,et al., Transplantation 54:573-6, 1992). The use of sCR1 protects andextends the survival time of the transplanted organ, implicating thecomplement pathway in the pathogenesis of organ survival (Leventhal, J.R., et al., Transplantation 55:857-66, 1993; Pruitt, S. K., et al.,Transplantation 57:363-70, 1994).

Suitable additional complement inhibitors for use in combination withthe compositions of the present invention also include, by way ofexample, MoAbs such as those being developed by Alexion Pharmaceuticals,Inc., New Haven, Conn., and anti-properdin MoAbs.

When used in the treatment of arthritides (e.g., osteoarthritis andrheumatoid arthritis), the MASP-2 inhibitory agent of the presentinvention may be combined with one or more chondroprotective agents,which may include one or more promoters of cartilage anabolism and/orone or more inhibitors of cartilage catabolism, and suitably both ananabolic agent and a catabolic inhibitory agent, for concomitantadministration. Suitable anabolic promoting chondroprotective agentsinclude interleukin (IL) receptor agonists including IL-4, IL-10, IL-13,rhlL-4, rhIL-10 and rhIL-13, and chimeric IL-4, IL-10, or IL-13;Transforming growth factor-β superfamily agonists, including TGF-β,TGF-Iβ1, TGF-β2, TGF-β3, bone morphogenic proteins including BMP-2,BMP-4, BMP-5, BMP-6, BMP-7 (OP-1), and OP-2/BMP-8,growth-differentiation factors including GDF-5, GDF-6 and GDF-7,recombinant TGF-βs and BMPs, and chimeric TGF-βs and BMPs; insulin-likegrowth factors including IGF-1; and fibroblast growth factors includingbFGF. Suitable catabolic inhibitory chondroprotective agents includeInterleukin-1 (IL-1) receptor antagonists (IL-bra), including solublehuman IL-1 receptors (shuIL-1R), rshuIL-1R, rhIL-1ra, anti-IL1-antibody,AF11567, and AF12198; Tumor Necrosis Factor (TNF) Receptor Antagonists(TNF-α), including soluble receptors including sTNFR1 and sTNFRII,recombinant TNF soluble receptors, and chimeric TNF soluble receptorsincluding chimeric rhTNFR:Fc, Fc fusion soluble receptors and anti-TNFantibodies; cyclooxygenase-2 (COX-2 specific) inhibitors, including DuP697, SC-58451, celecoxib, rofecoxib, nimesulide, diclofenac, meloxicam,piroxicam, NS-398, RS-57067, SC-57666, SC-58125, flosulide, etodolac,L-745,337 and DFU-T-614; Mitogen-activated protein kinase (MAPK)inhibitors, including inhibitors of ERK1, ERK2, SAPK1, SAPK2a, SAPK2b,SAPK2d, SAPK3, including SB 203580, SB 203580 iodo, SB202190, SB 242235,SB 220025, RWJ 67657, RWJ 68354, FR 133605, L-167307, PD 98059, PD169316; inhibitors of nuclear factor kappa B (NFκB), including caffeicacid phenylethyl ester (CAPE), DM-CAPE, SN-50 peptide, hymenialdisineand pyrolidone dithiocarbamate; nitric oxide synthase (NOS) inhibitors,including N^(G)-monomethyl-L-arginine, 1400W, diphenyleneiodium,S-methyl isothiourea, S-(aminoethyl) isothiourea,L-N⁶-(1-iminoethyl)lysine, 1,3-PBITU, 2-ethyl-2-thiopseudourea,aminoguanidine, N′-nitro-L-arginine, and N′-nitro-L-arginine methylester, inhibitors of matrix metalloproteinases (MMPs), includinginhibitors of MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9, MMP-10, MMP-11,MMP-12, MMP-13, MMP-14 and MMP-15, and including U-24522, minocycline,4-Abz-Gly-Pro-D-Leu-D-Ala-NHOH, Ac-Arg-Cys-Gly-Val-Pro-Asp-NH₂, rhumanTIMP1, rhuman TIMP2, and phosphoramidon; cell adhesion molecules,including integrin agonists and antagonists including αVβ3 MoAb LM 609and echistatin; anti-chemotactic agents including F-Met-Leu-Phereceptors, IL-8 receptors, MCP-1 receptors and MIP1-I/RANTES receptors;intracellular signaling inhibitors, including (a) protein kinaseinhibitors, including both (i) protein kinase C (PKC) inhibitors(isozyme) including calphostin C, G-6203 and GF 109203X, and (ii)protein tyrosine kinase inhibitors; (b) modulators of intracellularprotein tyrosine phosphatases (PTPases); and (c) inhibitors of SH2domains (src Homology₂ domains).

For some applications, it may be beneficial to administer the MASP-2inhibitory agents of the present invention in combination with a spasminhibitory agent. For example, for urogenital applications, it may bebeneficial to include at least one smooth muscle spasm inhibitory agentand/or at least one anti-inflammation agent, and for vascular proceduresit may be useful to include at least one vasospasm inhibitor and/or atleast one anti-inflammation agent and/or at least one anti-restenosisagent. Suitable examples of spasm inhibitory agents include: serotonin₂receptor subtype antagonists; tachykinin receptor antagonists; nitricoxide donors; ATP-sensitive potassium channel openers; calcium channelantagonists; and endothelin receptor antagonists.

Pharmaceutical Carriers and Delivery Vehicles

In general, the MASP-2 inhibitory agent compositions of the presentinvention, combined with any other selected therapeutic agents, aresuitably contained in a pharmaceutically acceptable carrier. The carrieris non-toxic, biocompatible and is selected so as not to detrimentallyaffect the biological activity of the MASP-2 inhibitory agent (and anyother therapeutic agents combined therewith). Exemplary pharmaceuticallyacceptable carriers for peptides are described in U.S. Pat. No.5,211,657 to Yamada. The anti-MASP-2 antibodies and inhibitory peptidesuseful in the invention may be formulated into preparations in solid,semi-solid, gel, liquid or gaseous forms such as tablets, capsules,powders, granules, ointments, solutions, depositories, inhalants andinjections allowing for oral, parenteral or surgical administration. Theinvention also contemplates local administration of the compositions bycoating medical devices and the like.

Suitable carriers for parenteral delivery via injectable, infusion orirrigation and topical delivery include distilled water, physiologicalphosphate-buffered saline, normal or lactated Ringer's solutions,dextrose solution, Hank's solution, or propanediol. In addition,sterile, fixed oils may be employed as a solvent or suspending medium.For this purpose any biocompatible oil may be employed includingsynthetic mono- or diglycerides. In addition, fatty acids such as oleicacid find use in the preparation of injectables. The carrier and agentmay be compounded as a liquid, suspension, polymerizable ornon-polymerizable gel, paste or salve.

The carrier may also comprise a delivery vehicle to sustain (i.e.,extend, delay or regulate) the delivery of the agent(s) or to enhancethe delivery, uptake, stability or pharmacokinetics of the therapeuticagent(s). Such a delivery vehicle may include, by way of non-limitingexample, microparticles, microspheres, nanospheres or nanoparticlescomposed of proteins, liposomes, carbohydrates, synthetic organiccompounds, inorganic compounds, polymeric or copolymeric hydrogels andpolymeric micelles. Suitable hydrogel and micelle delivery systemsinclude the PEO:PHB:PEO copolymers and copolymer/cyclodextrin complexesdisclosed in WO 2004/009664 A2 and the PEO and PEO/cyclodextrincomplexes disclosed in U.S. Patent Application Publication No.2002/0019369 Al. Such hydrogels may be injected locally at the site ofintended action, or subcutaneously or intramuscularly to form asustained release depot.

For intra-articular delivery, the MASP-2 inhibitory agent may be carriedin above-described liquid or gel carriers that are injectable,above-described sustained-release delivery vehicles that are injectable,or a hyaluronic acid or hyaluronic acid derivative.

For oral administration of non-peptidergic agents, the MASP-2 inhibitoryagent may be carried in an inert filler or diluent such as sucrose,cornstarch, or cellulose.

For topical administration, the MASP-2 inhibitory agent may be carriedin ointment, lotion, cream, gel, drop, suppository, spray, liquid orpowder, or in gel or microcapsular delivery systems via a transdermalpatch.

Various nasal and pulmonary delivery systems, including aerosols,metered-dose inhalers, dry powder inhalers, and nebulizers, are beingdeveloped and may suitably be adapted for delivery of the presentinvention in an aerosol, inhalant, or nebulized delivery vehicle,respectively.

For intrathecal (IT) or intracerebroventricular (ICV) delivery,appropriately sterile delivery systems (e.g., liquids; gels,suspensions, etc.) can be used to administer the present invention.

The compositions of the present invention may also include biocompatibleexcipients, such as dispersing or wetting agents, suspending agents,diluents, buffers, penetration enhancers, emulsifiers, binders,thickeners, flavouring agents (for oral administration).

Pharmaceutical Carriers for Antibodies and Peptides

More specifically with respect to anti-MASP-2 antibodies and inhibitorypeptides, exemplary formulations can be parenterally administered asinjectable dosages of a solution or suspension of the compound in aphysiologically acceptable diluent with a pharmaceutical carrier thatcan be a sterile liquid such as water, oils, saline, glycerol orethanol. Additionally, auxiliary substances such as wetting oremulsifying agents, surfactants, pH buffering substances and the likecan be present in compositions comprising anti-MASP-2 antibodies andinhibitory peptides. Additional components of pharmaceuticalcompositions include petroleum (such as of animal, vegetable orsynthetic origin), for example, soybean oil and mineral oil. In general,glycols such as propylene glycol or polyethylene glycol are preferredliquid carriers for injectable solutions.

The anti-MASP-2 antibodies and inhibitory peptides can also beadministered in the form of a depot injection or implant preparationthat can be formulated in such a manner as to permit a sustained orpulsatile release of the active agents.

Pharmaceutically Acceptable Carriers For Expression Inhibitors

More specifically with respect to expression inhibitors useful in themethods of the invention, compositions are provided that comprise anexpression inhibitor as described above and a pharmaceuticallyacceptable carrier or diluent. The composition may further comprise acolloidal dispersion system.

Pharmaceutical compositions that include expression inhibitors mayinclude, but are not limited to, solutions, emulsions, andliposome-containing formulations. These compositions may be generatedfrom a variety of components that include, but are not limited to,preformed liquids, self-emulsifying solids and self-emulsifyingsemisolids. The preparation of such compositions typically involvescombining the expression inhibitor with one or more of the following:buffers, antioxidants, low molecular weight polypeptides, proteins,amino acids, carbohydrates including glucose, sucrose or dextrins,chelating agents such as EDTA, glutathione and other stabilizers andexcipients. Neutral buffered saline or saline mixed with non-specificserum albumin are examples of suitable diluents.

In some embodiments, the compositions may be prepared and formulated asemulsions which are typically heterogeneous systems of one liquiddispersed in another in the form of droplets (see, Idson, inPharmaceutical Dosage Forms, Vol. 1, Rieger and Banker (eds.), MarcekDekker, Inc., N.Y., 1988). Examples of naturally occurring emulsifiersused in emulsion formulations include acacia, beeswax, lanolin, lecithinand phosphatides.

In one embodiment, compositions including nucleic acids can beformulated as microemulsions. A microemulsion, as used herein refers toa system of water, oil, and amphiphile, which is a single opticallyisotropic and thermodynamically stable liquid solution (see Rosoff inPharmaceutical Dosage Forms, Vol. 1). The method of the invention mayalso use liposomes for the transfer and delivery of antisenseoligonucleotides to the desired site.

Pharmaceutical compositions and formulations of expression inhibitorsfor topical administration may include transdermal patches, ointments,lotions, creams, gels, drops, suppositories, sprays, liquids andpowders. Conventional pharmaceutical carriers, as well as aqueous,powder or oily bases and thickeners and the like may be used.

Modes of Administration

The pharmaceutical compositions comprising MASP-2 inhibitory agents maybe administered in a number of ways depending on whether a local orsystemic mode of administration is most appropriate for the conditionbeing treated. Additionally, as described herein above with respect toextracorporeal reperfusion procedures, MASP-2 inhibitory agents can beadministered via introduction of the compositions of the presentinvention to recirculating blood or plasma. Further, the compositions ofthe present invention can be delivered by coating or incorporating thecompositions on or into an implantable medical device.

Systemic Delivery

As used herein, the terms “systemic delivery” and “systemicadministration” are intended to include but are not limited to oral andparenteral routes including intramuscular (IM), subcutaneous,intravenous (IV), intra-arterial, inhalational, sublingual, buccal,topical, transdermal, nasal, rectal, vaginal and other routes ofadministration that effectively result in dispersement of the deliveredagent to a single or multiple sites of intended therapeutic action.Preferred routes of systemic delivery for the present compositionsinclude intravenous, intramuscular, subcutaneous and inhalational. Itwill be appreciated that the exact systemic administration route forselected agents utilized in particular compositions of the presentinvention will be determined in part to account for the agent'ssusceptibility to metabolic transformation pathways associated with agiven route of administration. For example, peptidergic agents may bemost suitably administered by routes other than oral.

MASP-2 inhibitory antibodies and polypeptides can be delivered into asubject in need thereof by any suitable means. Methods of delivery ofMASP-2 antibodies and polypeptides include administration by oral,pulmonary, parenteral (e.g., intramuscular, intraperitoneal, intravenous(IV) or subcutaneous injection), inhalation (such as via a fine powderformulation), transdermal, nasal, vaginal, rectal, or sublingual routesof administration, and can be formulated in dosage forms appropriate foreach route of administration.

By way of representative example, MASP-2 inhibitory antibodies andpeptides can be introduced into a living body by application to a bodilymembrane capable of absorbing the polypeptides, for example the nasal,gastrointestinal and rectal membranes. The polypeptides are typicallyapplied to the absorptive membrane in conjunction with a permeationenhancer. (See, e.g., Lee, V. H. L., Crit. Rev. Ther. Drug Carrier Sys.5:69, 1988; Lee, V. H. L., J. Controlled Release 13:213, 1990; Lee, V.H. L., Ed., Peptide and Protein Drug Delivery, Marcel Dekker, New York(1991); DeBoer, A. G., et al., J. Controlled Release 13:241, 1990.) Forexample, STDHF is a synthetic derivative of fusidic acid, a steroidalsurfactant that is similar in structure to the bile salts, and has beenused as a permeation enhancer for nasal delivery. (Lee, W. A., Biopharm.22, Nov./Dec. 1990.)

The MASP-2 inhibitory antibodies and polypeptides may be introduced inassociation with another molecule, such as a lipid, to protect thepolypeptides from enzymatic degradation. For example, the covalentattachment of polymers, especially polyethylene glycol (PEG), has beenused to protect certain proteins from enzymatic hydrolysis in the bodyand thus prolong half-life (Fuertges, F., et al., J. Controlled Release11:139, 1990). Many polymer systems have been reported for proteindelivery (Bae, Y. H., et al., J. Controlled Release 9:271, 1989; Hori,R., et al., Pharm. Res. 6:813, 1989; Yamakawa, I., et al., J. Pharm.Sci. 79:505, 1990; Yoshihiro, I., et al., J. Controlled Release 10:195,1989; Asano, M., et al., J. Controlled Release 9:111, 1989; Rosenblatt,J., et al., J. Controlled Release 9:195, 1989; Makino, K., J. ControlledRelease 12:235, 1990; Takakura, Y., et al., J. Pharm. Sci. 78:117, 1989;Takakura, Y., et al., J. Pharm. Sci. 78:219, 1989).

Recently, liposomes have been developed with improved serum stabilityand circulation half-times (see, e.g., U.S. Pat. No. 5,741,516, toWebb). Furthermore, various methods of liposome and liposome-likepreparations as potential drug carriers have been reviewed (see, e.g.,U.S. Pat. No. 5,567,434, to Szoka; U.S. Pat. No. 5,552,157, to Yagi;U.S. Pat. No. 5,565,213, to Nakamori; U.S. Pat. No. 5,738,868, toShinkarenko; and U.S. Pat. No. 5,795,587, to Gao).

For transdermal applications, the MASP-2 inhibitory antibodies andpolypeptides may be combined with other suitable ingredients, such ascarriers and/or adjuvants. There are no limitations on the nature ofsuch other ingredients, except that they must be pharmaceuticallyacceptable for their intended administration, and cannot degrade theactivity of the active ingredients of the composition. Examples ofsuitable vehicles include ointments, creams, gels, or suspensions, withor without purified collagen. The MASP-2 inhibitory antibodies andpolypeptides may also be impregnated into transdermal patches, plasters,and bandages, preferably in liquid or semi-liquid form.

The compositions of the present invention may be systemicallyadministered on a periodic basis at intervals determined to maintain adesired level of therapeutic effect. For example, compositions may beadministered, such as by subcutaneous injection, every two to four weeksor at less frequent intervals. The dosage regimen will be determined bythe physician considering various factors that may influence the actionof the combination of agents. These factors will include the extent ofprogress of the condition being treated, the patient's age, sex andweight, and other clinical factors. The dosage for each individual agentwill vary as a function of the MASP-2 inhibitory agent that is includedin the composition, as well as the presence and nature of any drugdelivery vehicle (e.g., a sustained release delivery vehicle). Inaddition, the dosage quantity may be adjusted to account for variationin the frequency of administration and the pharmacokinetic behavior ofthe delivered agent(s).

Local Delivery

As used herein, the term “local” encompasses application of a drug in oraround a site of intended localized action, and may include for exampletopical delivery to the skin or other affected tissues, ophthalmicdelivery, intrathecal (IT), intracerebroventricular (ICV),intra-articular, intracavity, intracranial or intravesicularadministration, placement or irrigation. Local administration may bepreferred to enable administration of a lower dose, to avoid systemicside effects, and for more accurate control of the timing of deliveryand concentration of the active agents at the site of local delivery.Local administration provides a known concentration at the target site,regardless of interpatient variability in metabolism, blood flow, etc.Improved dosage control is also provided by the direct mode of delivery.

Local delivery of a MASP-2 inhibitory agent may be achieved in thecontext of surgical methods for treating a disease or condition, such asfor example during procedures such as arterial bypass surgery,atherectomy, laser procedures, ultrasonic procedures, balloonangioplasty and stent placement. For example, a MASP-2 inhibitor can beadministered to a subject in conjunction with a balloon angioplastyprocedure. A balloon angioplasty procedure involves inserting a catheterhaving a deflated balloon into an artery. The deflated balloon ispositioned in proximity to the atherosclerotic plaque and is inflatedsuch that the plaque is compressed against the vascular wall. As aresult, the balloon surface is in contact with the layer of vascularendothelial cells on the surface of the blood vessel. The MASP-2inhibitory agent may be attached to the balloon angioplasty catheter ina manner that permits release of the agent at the site of theatherosclerotic plaque. The agent may be attached to the ballooncatheter in accordance with standard procedures known in the art. Forexample, the agent may be stored in a compartment of the ballooncatheter until the balloon is inflated, at which point it is releasedinto the local environment. Alternatively, the agent may be impregnatedon the balloon surface, such that it contacts the cells of the arterialwall as the balloon is inflated. The agent may also be delivered in aperforated balloon catheter such as those disclosed in Flugelman, M. Y.,et al., Circulation 85:1110-1117, 1992. See also published PCTApplication WO 95/23161 for an exemplary procedure for attaching atherapeutic protein to a balloon angioplasty catheter. Likewise, theMASP-2 inhibitory agent may be included in a gel or polymeric coatingapplied to a stent, or may be incorporated into the material of thestent, such that the stent elutes the MASP-2 inhibitory agent aftervascular placement.

MASP-2 inhibitory compositions used in the treatment of arthritides andother musculoskeletal disorders may be locally delivered byintra-articular injection. Such compositions may suitably include asustained release delivery vehicle. As a further example of instances inwhich local delivery may be desired, MASP-2 inhibitory compositions usedin the treatment of urogenital conditions may be suitably instilledintravesically or within another urogenital structure.

Coatings on a Medical Device

MASP-2 inhibitory agents such as antibodies and inhibitory peptides maybe immobilized onto (or within) a surface of an implantable orattachable medical device. The modified surface will typically be incontact with living tissue after implantation into an animal body. By“implantable or attachable medical device” is intended any device thatis implanted into, or attached to, tissue of an animal body, during thenormal operation of the device (e.g., stents and implantable drugdelivery devices). Such implantable or attachable medical devices can bemade from, for example, nitrocellulose, diazocellulose, glass,polystyrene, polyvinylchloride, polypropylene, polyethylene, dextran,Sepharose, agar, starch, nylon, stainless steel, titanium andbiodegradable and/or biocompatible polymers. Linkage of the protein to adevice can be accomplished by any technique that does not destroy thebiological activity of the linked protein, for example by attaching oneor both of the N—C-terminal residues of the protein to the device.Attachment may also be made at one or more internal sites in theprotein. Multiple attachments (both internal and at the ends of theprotein) may also be used. A surface of an implantable or attachablemedical device can be modified to include functional groups (e.g.,carboxyl, amide, amino, ether, hydroxyl, cyano, nitrido, sulfanamido,acetylinic, epoxide, silanic, anhydric, succinimic, azido) for proteinimmobilization thereto. Coupling chemistries include, but are notlimited to, the formation of esters, ethers, amides, azido andsulfanamido derivatives, cyanate and other linkages to the functionalgroups available on MASP-2 antibodies or inhibitory peptides. MASP-2antibodies or inhibitory fragments can also be attached non-covalentlyby the addition of an affinity tag sequence to the protein, such as GST(D. B. Smith and K. S. Johnson, Gene 67:31, 1988), polyhistidines (E.Hochuli et al., J. Chromatog. 411:77, 1987), or biotin. Such affinitytags may be used for the reversible attachment of the protein to adevice.

Proteins can also be covalently attached to the surface of a devicebody, for example, by covalent activation of the surface of the medicaldevice. By way of representative example, matricellular protein(s) canbe attached to the device body by any of the following pairs of reactivegroups (one member of the pair being present on the surface of thedevice body, and the other member of the pair being present on thematricellular protein(s)): hydroxyl/carboxylic acid to yield an esterlinkage; hydroxyl/anhydride to yield an ester linkage;hydroxyl/isocyanate to yield a urethane linkage. A surface of a devicebody that does not possess useful reactive groups can be treated withradio-frequency discharge plasma (RFGD) etching to generate reactivegroups in order to allow deposition of matricellular protein(s) (e.g.,treatment with oxygen plasma to introduce oxygen-containing groups;treatment with propyl amino plasma to introduce amine groups).

MASP-2 inhibitory agents comprising nucleic acid molecules such asantisense, RNAi-or DNA-encoding peptide inhibitors can be embedded inporous matrices attached to a device body. Representative porousmatrices useful for making the surface layer are those prepared fromtendon or dermal collagen, as may be obtained from a variety ofcommercial sources (e.g., Sigma and Collagen Corporation), or collagenmatrices prepared as described in U.S. Pat. No. 4,394,370, to Jefferies,and U.S. Pat. No. 4,975,527, to Koezuka. One collagenous material istermed UltraFiber™ and is obtainable from Norian Corp. (Mountain View,Calif.).

Certain polymeric matrices may also be employed if desired, and includeacrylic ester polymers and lactic acid polymers, as disclosed, forexample, in U.S. Pat. Nos. 4,526,909 and 4,563,489, to Urist. Particularexamples of useful polymers are those of orthoesters, anhydrides,propylene-cofumarates, or a polymer of one or more a-hydroxy carboxylicacid monomers, (e.g., α-hydroxy acetic acid (glycolic acid) and/ora-hydroxy propionic acid (lactic acid)).

Treatment Regimens

In prophylactic applications, the pharmaceutical compositions areadministered to a subject susceptible to, or otherwise at risk of, acondition associated with MASP-2-dependent complement activation in anamount sufficient to eliminate or reduce the risk of developing symptomsof the condition. In therapeutic applications, the pharmaceuticalcompositions are administered to a subject suspected of, or alreadysuffering from, a condition associated with MASP-2-dependent complementactivation in a therapeutically effective amount sufficient to relieve,or at least partially reduce, the symptoms of the condition. In bothprophylactic and therapeutic regimens, compositions comprising MASP-2inhibitory agents may be administered in several dosages until asufficient therapeutic outcome has been achieved in the subject.Application of the MASP-2 inhibitory compositions of the presentinvention may be carried out by a single administration of thecomposition, or a limited sequence of administrations, for treatment ofan acute condition, e.g., reperfusion injury or other traumatic injury.Alternatively, the composition may be administered at periodic intervalsover an extended period of time for treatment of chronic conditions,e.g., arthritides or psoriasis.

The methods and compositions of the present invention may be used toinhibit inflammation and related processes that typically result fromdiagnostic and therapeutic medical and surgical procedures. To inhibitsuch processes, the MASP-2 inhibitory composition of the presentinvention may be applied periprocedurally. As used herein“periprocedurally” refers to administration of the inhibitorycomposition preprocedurally and/or intraprocedurally and/orpostprocedurally, i.e., before the procedure, before and during theprocedure, before and after the procedure, before, during and after theprocedure, during the procedure, during and after the procedure, orafter the procedure. Periprocedural application may be carried out bylocal administration of the composition to the surgical or proceduralsite, such as by injection or continuous or intermittent irrigation ofthe site or by systemic administration. Suitable methods for localperioperative delivery of MASP-2 inhibitory agent solutions aredisclosed in U.S. Pat. No. 6,420,432 to Demopulos and U.S. Pat. No.6,645,168 to Demopulos. Suitable methods for local delivery ofchondroprotective compositions including MASP-2 inhibitory agent(s) aredisclosed in International PCT Patent Application WO 01/07067 A2.Suitable methods and compositions for targeted systemic delivery ofchondroprotective compositions including MASP-2 inhibitory agent(s) aredisclosed in International PCT Patent Application WO 03/063799 A2.

VI. EXAMPLES

The following examples merely illustrate the best mode now contemplatedfor practicing the invention, but should not be construed to limit theinvention. All literature citations herein are expressly incorporated byreference.

Example 1

This example describes the generation of a mouse strain deficient inMASP-2 (MASP-2−/−) but sufficient of MAp19 (MAp19+/+).

Materials and Methods: The targeting vector pKO-NTKV 1901 was designedto disrupt the three exons coding for the C-terminal end of murineMASP-2, including the exon that encodes the serine protease domain, asshown in FIG. 4. PKO-NTKV 1901 was used to transfect the murine ES cellline E14.1a (SV129 Ola). Neomycin-resistant and ThymidineKinase-sensitive clones were selected. 600 ES clones were screened and,of these, four different clones were identified and verified by southernblot to contain the expected selective targeting and recombination eventas shown in FIG. 4. Chimeras were generated from these four positiveclones by embryo transfer. The chimeras were then backcrossed in thegenetic background C57/BL6 to create transgenic males. The transgenicmales were crossed with females to generate F1s with 50% of theoffspring showing heterozygosity for the disrupted MASP-2 gene. Theheterozygous mice were intercrossed to generate homozygous MASP-2deficient offspring, resulting in heterozygous and wild-type mice in theration of 1:2:1, respectively.

Results and Phenotype: The resulting homozygous MASP-2−/− deficient micewere found to be viable and fertile and were verified to be MASP-2deficient by southern blot to confirm the correct targeting event, byNorthern blot to confirm the absence of MASP-2 mRNA, and by Western blotto confirm the absence of MASP-2 protein (data not shown). The presenceof MAp19 mRNA and the absence of MASP-2 mRNA were further confirmedusing time-resolved RT-PCR on a LightCycler machine. The MASP-2−/− micedo continue to express MAp19, MASP-1, and MASP-3 mRNA and protein asexpected (data not shown). The presence and abundance of mRNA in theMASP-2−/− mice for Properdin, Factor B, Factor D, C4, C2, and C3 wasassessed by LightCycler analysis and found to be identical to that ofthe wild-type littermate controls (data not shown). The plasma fromhomozygous MASP-2−/− mice is totally deficient oflectin-pathway-mediated complement activation and alternative pathwaycomplement activation as further described in Example 2.

Generation of a MASP-2−/− strain on a pure C57BL6 Background: TheMASP-2−/− mice are back-crossed with a pure C57BL6 line for ninegenerations prior to use of the MASP-2−/− strain as an experimentalanimal model.

Example 2

This example demonstrates that MASP-2 is required for complementactivation via the alternative and the lectin pathway.

Methods and Materials:

Lectin pathway specific C4 Cleavage Assay: A C4 cleavage assay has beendescribed by Petersen, et al., J. Immunol. Methods 257:107 (2001) thatmeasures lectin pathway activation resulting from lipoteichoic acid(LTA) from S. aureus, which binds L-ficolin. The assay described inExample 11 was adapted to measure lectin pathway activation via MBL bycoating the plate with LPS and mannan or zymosan prior to adding serumfrom MASP-2 −/− mice as described below. The assay was also modified toremove the possibility of C4 cleavage due to the classical pathway. Thiswas achieved by using a sample dilution buffer containing 1 M NaCl,which permits high affinity binding of lectin pathway recognitioncomponents to their ligands but prevents activation of endogenous C4,thereby excluding the participation of the classical pathway bydissociating the C1 complex. Briefly described, in the modified assayserum samples (diluted in high salt (1 M NaCl) buffer) are added toligand-coated plates, followed by the addition of a constant amount ofpurified C4 in a buffer with a physiological concentration of salt.Bound recognition complexes containing MASP-2 cleave the C4, resultingin C4b deposition.

Assay Methods:

1) Nunc Maxisorb microtiter plates (Maxisorb, Nunc, Cat. No. 442404,Fisher Scientific) were coated with 1 μg/ml mannan (M7504 Sigma) or anyother ligand (e.g., such as those listed below) diluted in coatingbuffer (15 mM Na₂CO₃, 35 mM NaHCO₃, pH 9.6).

The following reagents were used in the assay:

-   -   a. mannan (1 μg/well mannan (M7504 Sigma) in 100 μl coating        buffer):    -   b. zymosan (1 μg/well zymosan (Sigma) in 100 μl coating buffer);    -   c. LTA (1 μg/well in 100 μl coating buffer or 2 μg/well in 20 μl        methanol)    -   d. 1 μg of the H-ficolin specific Mab 4H5 in coating buffer    -   e. PSA from Aerococcus viridans (2 μg/well in 100 μl coating        buffer)    -   f. 100 μl well of formalin-fixed S. aureus DSM20233 (OD₅₅₀=0.5)        in coating buffer.

2) The plates were incubated overnight at 4° C.

3) After overnight incubation, the residual protein binding sites weresaturated by incubated the plates with 0.1% HSA-TBS blocking buffer(0.1% (w/v) HSA in 10 mM Tris-CL, 140 mM NaCl, 1.5 mM NaN₃, pH 7.4) for1-3 hours, then washing the plates 3× with TBS/tween/Ca²⁺ (TBS with0.05% Tween 20 and 5 mM CaCl₂, 1 mM MgCl₂, pH 7.4).

4) Serum samples to be tested were diluted in MBL-binding buffer (1 MNaCl) and the diluted samples were added to the plates and incubatedovernight at 4° C. Wells receiving buffer only were used as negativecontrols.

5) Following incubation overnight at 4° C., the plates were washed 3×with TBS/tween/Ca2+. Human C4 (100 μl/well of 1 μg/ml diluted in BBS (4mM barbital, 145 mM NaCl, 2 mM CaCl₂, 1 mM MgCl₂, pH 7.4)) was thenadded to the plates and incubated for 90 minutes at 37° C. The plateswere washed again 3× with TBS/tween/Ca²⁺.

6) C4b deposition was detected with an alkaline phosphatase-conjugatedchicken anti-human C4c (diluted 1:1000 in TBS/tween/Ca²⁺), which wasadded to the plates and incubated for 90 minutes at room temperature.The plates were then washed again 3× with TB S/tween/Ca²⁺.

7) Alkaline phosphatase was detected by adding 100 μl of p-nitrophenylphosphate substrate solution, incubating at room temperature for 20minutes, and reading the OD₄₀₅ in a microtiter plate reader.

Results: FIGS. 6A-B show the amount of C4b deposition on mannan (FIG.6A) and zymosan (FIG. 6B) in serum dilutions from MASP-2+/+ (crosses),MASP-2+/− (closed circles) and MASP-2−/− (closed triangles). FIG. 6Cshows the relative C4 convertase activity on plates coated with zymosan(white bars) or mannan (shaded bars) from MASP-2−/+mice (n=5) andMASP-2−/− mice (n=4) relative to wild-type mice (n=5) based on measuringthe amount of C4b deposition normalized to wild-type serum. The errorbars represent the standard deviation. As shown in FIGS. 6A-C, plasmafrom MASP-2−/− mice is totally deficient in lectin-pathway-mediatedcomplement activation on mannan and on zymosan coated plates. Theseresults clearly demonstrate that MASP-2, but not MASP-1 or MASP-3, isthe effector component of the lectin pathway.

C3b Deposition Assay:

1) Nunc Maxisorb microtiter plates (Maxisorb, Nunc, cat. No. 442404,Fisher Scientific) are coated with 1 μg/well mannan (M7504 Sigma) or anyother ligand diluted in coating buffer (15 mM Na₂CO₃, 35 mM NaHCO₃, pH9.6) and incubated overnight at 4° C.

2) Residual protein binding sites are saturated by incubating the platewith 0.1% HSA-TBS blocking buffer (0.1% (w/v) HSA in 10 mM Tris-CL, 140mM NaCl, 1.5 mM NaN₃, pH 7.4) for 1-3 hours.

3) Plates are washed in TBS/tw/Ca⁺⁺ (TBS with 0.05% Tween 20 and 5 mMCaCl₂) and diluted BBS is added to serum samples (4 mM barbital, 145 mMNaCl, 2 mM CaCl₂, 1 mM MgCl₂, pH 7.4). Wells receiving only buffer areused as negative controls. A control set of serum samples obtained fromwild-type or MASP-2−/− mice are C1q depleted prior to use in the assay.C1q-depleted mouse serum was prepared using protein-A-coupled Dynabeads(Dynal Biotech, Oslo, Norway) coated with rabbit anti-human C1q IgG(Dako, Glostrup, Denmark), according to the supplier's instructions.

4) Following incubation overnight at 4° C., and another wash withTBS/tw/Ca⁺⁺, converted and bound C3 is detected with a polyclonalanti-human-C3c Antibody (Dako A 062) diluted in TBS/tw/Ca⁺⁺ at 1:1000).The secondary antibody is goat anti-rabbit IgG (whole molecule)conjugated to alkaline-phosphatase (Sigma Immunochemicals A-3812)diluted 1:10,000 in TBS/tw/Ca⁺⁺. The presence of alternative complementpathway (AP) is determined by addition of 100 μl substrate solution(Sigma Fast p-Nitrophenyl Phosphate tablet sets, Sigma) and incubationat room temperature. Hydrolysis is monitored quantitatively by measuringthe absorption at 405 nm in a microtiter plate reader. A standard curveis prepared for each analysis using serial dilutions of plasma/serumsamples.

Results: The results shown in FIGS. 7A and 7B are from pooled serum fromseveral mice. The crosses represent MASP-2+/+ serum, the filled circlesrepresent C1q depleted MASP-2+/+ serum, the open squares representMASP-2−/− serum and the open triangles represent C1q depleted MASP-2−/−serum. As shown in FIGS. 7A-B, serum from MASP-2−/− mice tested in a C3bdeposition assay results in very low levels of C3 activation on mannan(FIG. 7A) and on zymosan (FIG. 7B) coated plates. This result clearlydemonstrates that MASP-2 is required to contribute the initial C3bgeneration from C3 to initiate the alternative complement pathway. Thisis a surprising result in view of the widely accepted view thatcomplement factors C3, factor B, factor D and properdin form anindependent functional alternative pathway in which C3 can undergo aspontaneous conformational change to a “C3b-like” form which thengenerates a fluid phase convertase iC3Bb and deposits C3b molecules onactivation surfaces such as zymosan.

Recombinant MASP-2 Reconstitutes Lectin Pathway-Dependent C4 Activationin Serum from the MASP-2−/− Mice

In order to establish that the absence of MASP-2 was the direct cause ofthe loss of lectin pathway-dependent C4 activation in the MASP-2−/−mice, the effect of adding recombinant MASP-2 protein to serum sampleswas examined in the C4 cleavage assay described above. Functionallyactive murine MASP-2 and catalytically inactive murine MASP-2A (in whichthe active-site serine residue in the serine protease domain wassubstituted for the alanine residue) recombinant proteins were producedand purified as described below in Example 5. Pooled serum from 4 MASP-2−/− mice was pre-incubated with increasing protein concentrations ofrecombinant murine MASP-2 or inactive recombinant murine MASP-2A and C4convertase activity was assayed as described above.

Results: As shown in FIG. 8, the addition of functionally active murinerecombinant MASP-2 protein (shown as open triangles) to serum obtainedfrom the MASP-2−/− mice restored lectin pathway-dependent C4 activationin a protein concentration dependent manner, whereas the catalyticallyinactive murine MASP-2A protein (shown as stars) did not restore C4activation. The results shown in FIG. 8 are normalized to the C4activation observed with pooled wild-type mouse serum (shown as a dottedline).

Example 3

This example describes the generation of a transgenic mouse strain thatis murine MASP-2−/−, MAp19+/+ and that expresses a human MASP-2transgene (a murine MASP-2 knock-out and a human MASP-2 knock-in).

Materials and Methods: A minigene encoding human MASP-2 called “minihMASP-2” (SEQ ID NO:49) as shown in FIG. 5 was constructed whichincludes the promoter region of the human MASP 2 gene, including thefirst 3 exons (exon 1 to exon 3) followed by the cDNA sequence thatrepresents the coding sequence of the following 8 exons, therebyencoding the full-length MASP-2 protein driven by its endogenouspromoter. The mini hMASP-2 construct was injected into fertilized eggsof MASP-2−/− in order to replace the deficient murine MASP 2 gene bytransgenically expressed human MASP-2.

Example 4

This example describes the isolation of human MASP-2 protein inproenzyme form from human serum.

Method of human MASP-2 isolation: A method for isolating MASP-2 fromhuman serum has been described in Matsushita et al., J. Immunol.165:2637-2642, 2000. Briefly, human serum is passed through a yeastmannan-Sepharose column using a 10 mM imidazole buffer (pH 6.0)containing 0.2 M NaCl, 20 mM CaCl₂, 0.2 mM NPGB, 20 μM p-APMSF, and 2%mannitol. The MASP-1 and MASP-2 proenzymes complex with MBL and elutewith the above buffer containing 0.3 M mannose. To separate proenzymesMASP-1 and MASP-2 from MBL, preparations containing the complex areapplied to anti-MBL-Sepharose and then MASPs are eluted with imidazolebuffer containing 20 mM EDTA and 1 M NaCl. Finally, proenzymes MASP-1and MASP-2 are separated from each other by passing throughanti-MASP-1-Sepharose in the same buffer as used for theanti-MBL-Sepharose. MASP-2 is recovered in the effluents, whereas MASP-1is eluted with 0.1 M glycine buffer (pH 2.2).

Example 5

This example describes the recombinant expression and protein productionof recombinant full-length human, rat and murine MASP-2, MASP-2 derivedpolypeptides, and catalytically inactivated mutant forms of MASP-2

Expression of Full-Length Human, Murine and Rat MASP-2:

The full length cDNA sequence of human MASP-2 (SEQ ID NO: 4) was alsosubcloned into the mammalian expression vector pCI-Neo (Promega), whichdrives eukaryotic expression under the control of the CMVenhancer/promoter region (described in Kaufman R. J. et al., NucleicAcids Research 19:4485-90, 1991; Kaufman, Methods in Enzymology,185:537-66 (1991)). The full length mouse cDNA (SEQ ID NO:50) and ratMASP-2 cDNA (SEQ ID NO:53) were each subcloned into the pED expressionvector. The MASP-2 expression vectors were then transfected into theadherent Chinese hamster ovary cell line DXB 1 using the standardcalcium phosphate transfection procedure described in Maniatis et al.,1989. Cells transfected with these constructs grew very slowly, implyingthat the encoded protease is cytotoxic.

In another approach, the minigene construct (SEQ ID NO:49) containingthe human cDNA of MASP-2 driven by its endogenous promoter istransiently transfected into Chinese hamster ovary cells (CHO). Thehuman MASP-2 protein is secreted into the culture media and isolated asdescribed below.

Expression of Full-Length Catalytically Inactive MASP-2:

Rationale: MASP-2 is activated by autocatalytic cleavage after therecognition subcomponents MBL or ficolins (either L-ficolin, H-ficolinor M-ficolin) bind to their respective carbohydrate pattern.Autocatalytic cleavage resulting in activation of MASP-2 often occursduring the isolation procedure of MASP-2 from serum, or during thepurification following recombinant expression. In order to obtain a morestable protein preparation for use as an antigen, a catalyticallyinactive form of MASP-2, designed as MASP-2A was created by replacingthe serine residue that is present in the catalytic triad of theprotease domain with an alanine residue in rat (SEQ ID NO:55 Ser617 toAla617); in mouse (SEQ ID NO:52 Ser617 to Ala617); or in human (SEQ IDNO:3 Ser618 to Ala618).

In order to generate catalytically inactive human and murine MASP-2Aproteins, site-directed mutagenesis was carried out using theoligonucleotides shown in TABLE 5. The oligonucleotides in TABLE 5 weredesigned to anneal to the region of the human and murine cDNA encodingthe enzymatically active serine and oligonucleotide contain a mismatchin order to change the serine codon into an alanine codon. For example,PCR oligonucleotides SEQ ID NOS:56-59 were used in combination withhuman MASP-2 cDNA (SEQ ID NO:4) to amplify the region from the startcodon to the enzymatically active serine and from the serine to the stopcodon to generate the complete open reading from of the mutated MASP-2Acontaining the Ser618 to Ala618 mutation. The PCR products were purifiedafter agarose gel electrophoresis and band preparation and singleadenosine overlaps were generated using a standard tailing procedure.The adenosine tailed MASP-2A was then cloned into the pGEM-T easyvector, transformed into E. coli.

A catalytically inactive rat MASP-2A protein was generated by kinasingand annealing SEQ ID NO:64 and SEQ ID NO:65 by combining these twooligonucleotides in equal molar amounts, heating at 100° C. for 2minutes and slowly cooling to room temperature. The resulting annealedfragment has Pstl and Xbal compatible ends and was inserted in place ofthe Pst1-Xba1 fragment of the wild-type rat MASP-2 cDNA (SEQ ID NO:53)to generate rat MASP-2A.

(SEQ ID NO: 64) 5′ GAGGTGACGCAGGAGGGGCATTAGTGTTT 3′ (SEQ ID NO: 65) 5′CTAGAAACACTAATGCCCCTCCTGCGTCACCTCTGCA 3′

The human, murine and rat MASP-2A were each further subcloned intoeither of the mammalian expression vectors pED or pCI-Neo andtransfected into the Chinese Hamster ovary cell line DXB1 as describedbelow.

In another approach, a catalytically inactive form of MASP-2 isconstructed using the method described in Chen et al., J. Biol. Chem.,276(28):25894-25902, 2001. Briefly, the plasmid containing thefull-length human MASP-2 cDNA (described in Thiel et al., Nature386:506, 1997) is digested with Xho1 and EcoR1 and the MASP-2 cDNA(described herein as SEQ ID NO:4) is cloned into the correspondingrestriction sites of the pFastBac1 baculovirus transfer vector (LifeTechnologies, NY). The MASP-2 serine protease active site at Ser618 isthen altered to Ala618 by substituting the double-strandedoligonucleotides encoding the peptide region amino acid 610-625 (SEQ IDNO:13) with the native region amino acids 610 to 625 to create a MASP-2full length polypeptide with an inactive protease domain. Constructionof Expression Plasmids Containing Polypeptide Regions Derived from HumanMasp-2.

The following constructs are produced using the MASP-2 signal peptide(residues 1-15 of SEQ ID NO:5) to secrete various domains of MASP-2. Aconstruct expressing the human MASP-2 CUBI domain (SEQ ID NO:8) is madeby PCR amplifying the region encoding residues 1-121 of MASP-2 (SEQ IDNO:6) (corresponding to the N-terminal CUB1 domain). A constructexpressing the human MASP-2 CUBIEGF domain (SEQ ID NO:9) is made by PCRamplifying the region encoding residues 1-166 of MASP-2 (SEQ ID NO:6)(corresponding to the N-terminal CUB 1EGF domain). A constructexpressing the human MASP-2 CUBIEGFCUBII domain (SEQ ID NO:10) is madeby PCR amplifying the region encoding residues 1-293 of MASP-2 (SEQ IDNO:6) (corresponding to the N-terminal CUBIEGFCUBII domain). The abovementioned domains are amplified by PCR using Vent_(R) polymerase andpBS-MASP-2 as a template, according to established PCR methods. The 5′primer sequence of the sense primer (5′-CGGGATCCATGAGGCTGCTGACCCTC-3′SEQ ID NO:34) introduces a BamHI restriction site (underlined) at the 5′end of the PCR products. Antisense primers for each of the MASP-2domains, shown below in TABLE 5, are designed to introduce a stop codon(boldface) followed by an EcoRI site (underlined) at the end of each PCRproduct. Once amplified, the DNA fragments are digested with BamHI andEcoRI and cloned into the corresponding sites of the pFastBacl vector.The resulting constructs are characterized by restriction mapping andconfirmed by dsDNA sequencing.

TABLE 5 MASP-2 PCR PRIMERS MASP-2 domain 5′ PCR Primer 3′ PCR PrimerSEQ ID NO: 8 5′CGGGATCCATGA 5′GGAATTCCTAGGCTGCAT CUBI (aa 1-121GGCTGCTGACCCT A (SEQ ID NO: 35) of SEQ ID NO: 6) C-3′ (SEQ ID NO: 34)SEQ ID NO: 9 5′CGGGATCCATGA 5′GGAATTCCTACAGGGCGC CUBIEGF (aa 1-166 GGCTGCTGACCCT T-3′ (SEQ ID NO: 36) of SEQ ID NO: 6) C-3′ (SEQ ID NO: 34)SEQ ID NO: 10 5′CGGGATCCATGA 5′GGAATTCCTAGTAGTGGA CUBIEGFCUBII (aa 1-GGCTGCTGACCCT T 3′ (SEQ ID NO: 37) 293 of SEQ ID C-3′ (SEQ ID NO: 34)NO: 6) SEQ ID NO: 4 5′ATGAGGCTGCTG 5′TTAAAATCACTAATTATG human MASP-2ACCCTCCTGGGCC TTCTCGATC 3′ (SEQ ID NO: TTC 3′ (SEQ ID NO:59) hMASP-2_reverse 56) hMASP-2_forward SEQ ID NO: 4 5′CAGAGGTGACGC5′GTGCCCCTCCTGCGTCAC human MASP-2 cDNA AGGAGGGGCAC 3′ CTCTG 3′(SEQ ID NO: 57) (SEQ ID NO: 58) hMASP-2_ala_reverse hMASP-2 ala forwardSEQ ID NO: 50 5′ATGAGGCTACTC 5′TTAGAAATTACTTATTAT Murine MASP-2 cDNAATCTTCCTGG 3′ GTTCTCAATCC 3′ (SEQ ID (SEQ ID NO: 60)NO: 63) mMASP-2_reverse mMASP-2_forward SEQ ID NO: 50 5′CCCCCCCTGCGT5′CTGCAGAGGTGACGCAG Murine MASP-2 cDNA CACCTCTGCAG 3′ GGGGGG 3′(SEQ ID NO: 61) (SEQ ID NO: 62) mMASP-2_ala_reverse mMASP-2_ala_forward

Recombinant Eukaryotic Expression of MASP-2 and Protein Production ofEnzymatically Inactive Mouse, Rat, and Human MASP-2A.

The MASP-2 and MASP-2A expression constructs described above weretransfected into DXB1 cells using the standard calcium phosphatetransfection procedure

(Maniatis et al., 1989). MASP-2A was produced in serum-free medium toensure that preparations were not contaminated with other serumproteins. Media was harvested from confluent cells every second day(four times in total). The level of recombinant MASP-2A averagedapproximately 1.5 mg/liter of culture medium for each of the threespecies. MASP-2A protein purification: The MASP-2A (Ser-Ala mutantdescribed above) was purified by affinity chromatography onMBP-A-agarose columns. This strategy enabled rapid purification withoutthe use of extraneous tags. MASP-2A (100-200 ml of medium diluted withan equal volume of loading buffer (50 mM Tris-Cl, pH 7.5, containing 150mM NaCl and 25 mM CaCl₂) was loaded onto an MBP-agarose affinity column(4 ml) pre-equilibrated with 10 ml of loading buffer. Following washingwith a further 10 ml of loading buffer, protein was eluted in 1 mlfractions with 50 mM Tris-Cl, pH 7.5, containing 1.25 M NaCl and 10 mMEDTA. Fractions containing the MASP-2A were identified bySDS-polyacrylamide gel electrophoresis. Where necessary, MASP-2A waspurified further by ion-exchange chromatography on a MonoQ column (HR5/5). Protein was dialysed with 50 mM Tris-Cl pH 7.5, containing 50 mMNaCl and loaded onto the column equilibrated in the same buffer.Following washing, bound MASP-2A was eluted with a 0.05-1 M NaClgradient over 10 ml.

Results: Yields of 0.25-0.5 mg of MASP-2A protein were obtained from 200ml of medium. The molecular mass of 77.5 kDa determined by MALDI-MS isgreater than the calculated value of the unmodified polypeptide (73.5kDa) due to glycosylation. Attachment of glycans at each of theN-glycosylation sites accounts for the observed mass. MASP-2A migratesas a single band on SDS-polyacrylamide gels, demonstrating that it isnot proteolytically processed during biosynthesis. The weight-averagemolecular mass determined by equilibrium ultracentrifugation is inagreement with the calculated value for homodimers of the glycosylatedpolypeptide.

Production of Recombinant Human MASP-2 Polypeptides

Another method for producing recombinant MASP-2 and MASP2A derivedpolypeptides is described in Thielens, N. M., et al., J. Immunol.166:5068-5077, 2001. Briefly, the Spodoptera frugiperda insect cells(Ready-Plaque Sf9 cells obtained from Novagen, Madison, Wis.) are grownand maintained in Sf900II serum-free medium (Life Technologies)supplemented with 50 IU/ml penicillin and 50 mg/ml streptomycin (LifeTechnologies). The Trichoplusia ni (High Five) insect cells (provided byJadwiga Chroboczek, Institut de Biologie Structurale, Grenoble, France)are maintained in TC100 medium (Life Technologies) containing 10% FCS(Dominique Dutscher, Brumath, France) supplemented with 50 IU/mlpenicillin and 50 mg/ml streptomycin. Recombinant baculoviruses aregenerated using the Bac-to-Bac system (Life Technologies). The bacmidDNA is purified using the Qiagen midiprep purification system (Qiagen)and is used to transfect Sf9 insect cells using cellfectin in 51900 IISFM medium (Life Technologies) as described in the manufacturer'sprotocol. Recombinant virus particles are collected 4 days later,titrated by virus plaque assay, and amplified as described by King andPossee, in The Baculovirus Expression System: A Laboratory Guide,Chapman and Hall Ltd., London, pp. 111-114, 1992.

High Five cells (1.75×10⁷ cells/175-cm² tissue culture flask) areinfected with the recombinant viruses containing MASP-2 polypeptides ata multiplicity of infection of 2 in Sf900 II SFM medium at 28° C. for 96h. The supernatants are collected by centrifugation and diisopropylphosphorofluoridate is added to a final concentration of 1 mM.

The MASP-2 polypeptides are secreted in the culture medium. The culturesupernatants are dialyzed against 50 mM NaCl, 1 mM CaCl₂, 50 mMtriethanolamine hydrochloride, pH 8.1, and loaded at 1.5 ml/min onto aQ-Sepharose Fast Flow column (Amersham Pharmacia Biotech) (2.8×12 cm)equilibrated in the same buffer. Elution is conducted by applying a 1.2liter linear gradient to 350 mM NaCl in the same buffer. Fractionscontaining the recombinant MASP-2 polypeptides are identified by Westernblot analysis, precipitated by addition of (NH₄)₂SO₄ to 60% (w/v), andleft overnight at 4° C. The pellets are resuspended in 145 mM NaCl, 1 mMCaCl₂, 50 mM triethanolamine hydrochloride, pH 7.4, and applied onto aTSK G3000 SWG column (7.5×600 mm) (Tosohaas, Montgomeryville, Pa.)equilibrated in the same buffer. The purified polypeptides are thenconcentrated to 0.3 mg/ml by ultrafiltration on Microsepmicroconcentrators (m.w. cut-off=10,000) (Filtron, Karlstein, Germany).

Example 6

This example describes a method of producing polyclonal antibodiesagainst MASP-2 polypeptides.

Materials and Methods:

MASP-2 Antigens: Polyclonal anti-human MASP-2 antiserum is produced byimmunizing rabbits with the following isolated MASP-2 polypeptides:human MASP-2 (SEQ ID NO:6) isolated from serum as described in Example4; recombinant human MASP-2 (SEQ ID NO:6), MASP-2A containing theinactive protease domain (SEQ ID NO:13), as described in Examples 4-5;and recombinant CUBI (SEQ ID NO:8), CUBEGFI (SEQ ID NO:9), andCUBEGFCUBII (SEQ ID NO:10) expressed as described above in Example 5.

Polyclonal antibodies: Six-week old Rabbits, primed with BCG (bacillusCalmette-Guerin vaccine) are immunized by injecting 100 μg of MASP-2polypeptide at 100 μg/ml in sterile saline solution. Injections are doneevery 4 weeks, with antibody titer monitored by ELISA assay as describedin Example 7. Culture supernatants are collected for antibodypurification by protein A affinity chromatography.

Example 7

This example describes a method for producing murine monoclonalantibodies against rat or human MASP-2 polypeptides.

Materials and Methods:

Male A/J mice (Harlan, Houston, Tex.), 8-12 weeks old, are injectedsubcutaneously with 100 μg human or rat rMASP-2 or rMASP-2A polypeptides(made as described in Example 4 or Example 5) in complete Freund'sadjuvant (Difco Laboratories, Detroit, Mich.) in 200 μl of phosphatebuffered saline (PBS) pH 7.4. At two-week intervals the mice are twiceinjected subcutaneously with 50 μg of human or rat rMASP-2 or rMASP-2Apolypeptide in incomplete Freund's adjuvant. On the fourth week the miceare injected with 50 μg of human or rat rMASP-2 or rMASP-2A polypeptidein PBS and are fused 4 days later.

For each fusion, single cell suspensions are prepared from the spleen ofan immunized mouse and used for fusion with Sp2/0 myeloma cells. 5×10⁸of the Sp2/0 and 5×10⁸ spleen cells are fused in a medium containing 50%polyethylene glycol (M.W. 1450) (Kodak, Rochester, N.Y.) and 5%dimethylsulfoxide (Sigma Chemical Co., St. Louis, Mo.). The cells arethen adjusted to a concentration of 1.5×10⁵ spleen cells per 200 μl ofthe suspension in Iscove medium (Gibco, Grand Island, N.Y.),supplemented with 10% fetal bovine serum, 100 units/ml of penicillin,100 μg/ml of streptomycin, 0.1 mM hypoxanthine, 0.4 μM aminopterin and16 μM thymidine. Two hundred microliters of the cell suspension areadded to each well of about twenty 96-well microculture plates. Afterabout ten days culture supernatants are withdrawn for screening forreactivity with purified factor MASP-2 in an ELISA assay.

ELISA Assay: Wells of Immulon 2 (Dynatech Laboratories, Chantilly, Va.)microtest plates are coated by adding 50 μl of purified hMASP-2 at 50ng/ml or rat rMASP-2 (or rMASP-2A) overnight at room temperature. Thelow concentration of MASP-2 for coating enables the selection ofhigh-affinity antibodies. After the coating solution is removed byflicking the plate, 200 μl of BLOTTO (non-fat dry milk) in PBS is addedto each well for one hour to block the non-specific sites. An hourlater, the wells are then washed with a buffer PBST (PBS containing0.05% Tween 20). Fifty microliters of culture supernatants from eachfusion well is collected and mixed with 50 μl of BLOTTO and then addedto the individual wells of the microtest plates. After one hour ofincubation, the wells are washed with PB ST. The bound murine antibodiesare then detected by reaction with horseradish peroxidase (HRP)conjugated goat anti-mouse IgG (Fc specific) (Jackson ImmunoResearchLaboratories, West Grove, Pa.) and diluted at 1:2,000 in BLOTTO.Peroxidase substrate solution containing 0.1% 3,3,5,5 tetramethylbenzidine (Sigma, St. Louis, Mo.) and 0.0003% hydrogen peroxide (Sigma)is added to the wells for color development for 30 minutes. The reactionis terminated by addition of 50 μl of 2M H₂SO₄ per well. The OpticalDensity at 450 nm of the reaction mixture is read with a BioTek ELISAReader (BioTek Instruments, Winooski, Vt.).

MASP-2 Binding Assay:

Culture supernatants that test positive in the MASP-2 ELISA assaydescribed above can be tested in a binding assay to determine thebinding affinity the MASP-2 inhibitory agents have for MASP-2. A similarassay can also be used to determine if the inhibitory agents bind toother antigens in the complement system.

Polystyrene microtiter plate wells (96-well medium binding plates,Corning Costar, Cambridge, Mass.) are coated with MASP-2 (20 ng/100μl/well, Advanced Research Technology, San Diego, Calif.) inphosphate-buffered saline (PBS) pH 7.4 overnight at 4° C. Afteraspirating the MASP-2 solution, wells are blocked with PBS containing 1%bovine serum albumin (BSA; Sigma Chemical) for 2 h at room temperature.Wells without MASP-2 coating serve as the background controls. Aliquotsof hybridoma supernatants or purified anti-MASP-2 MoAbs, at varyingconcentrations in blocking solution, are added to the wells. Following a2 h incubation at room temperature, the wells are extensively rinsedwith PBS. MASP-2-bound anti-MASP-2 MoAb is detected by the addition ofperoxidase-conjugated goat anti-mouse IgG (Sigma Chemical) in blockingsolution, which is allowed to incubate for 1 h at room temperature. Theplate is rinsed again thoroughly with PBS, and 100 μl of3,3′,5,5′-tetramethyl benzidine (TMB) substrate (Kirkegaard and PerryLaboratories, Gaithersburg, Md.) is added. The reaction of TMB isquenched by the addition of 100 μl of 1M phosphoric acid, and the plateis read at 450 nm in a microplate reader (SPECTRA MAX 250, MolecularDevices, Sunnyvale, Calif.).

The culture supernatants from the positive wells are then tested for theability to inhibit complement activation in a functional assay such asthe C4 cleavage assay as described in Example 2. The cells in positivewells are then cloned by limiting dilution. The MoAbs are tested againfor reactivity with hMASP-2 in an ELISA assay as described above. Theselected hybridomas are grown in spinner flasks and the spent culturesupernatant collected for antibody purification by protein A affinitychromatography.

Example 8

This example describes the generation of a MASP-2−/− knockout mouseexpressing human MASP-2 for use as a model in which to screen for MASP-2inhibitory agents.

Materials and Methods: A MASP-2−/− mouse as described in Example 1 and aMASP-2−/− mouse expressing a human MASP-2 transgene construct (humanMASP-2 knock-in) as described in Example 3 are crossed, and progeny thatare murine MASP-2−/−, murine MAp19+, human MASP-2+ are used to identifyhuman MASP-2 inhibitory agents.

Such animal models can be used as test substrates for the identificationand efficacy of MASP-2 inhibitory agents such as human anti-MASP-2antibodies, MASP-2 inhibitory peptides and nonpeptides, and compositionscomprising MASP-2 inhibitory agents. For example, the animal model isexposed to a compound or agent that is known to trigger MASP-2-dependentcomplement activation, and a MASP-2 inhibitory agent is administered tothe animal model at a sufficient time and concentration to elicit areduction of disease symptoms in the exposed animal.

In addition, the murine MASP-2−/−, MAp19+, human MASP-2+ mice may beused to generate cell lines containing one or more cell types involvedin a MASP-2-associated disease which can be used as a cell culture modelfor that disorder. The generation of continuous cell lines fromtransgenic animals is well known in the art, for example see Small, J.A., et al., Mol. Cell Biol., 5:642-48, 1985.

Example 9

This example describes a method of producing human antibodies againsthuman MASP-2 in a MASP-2 knockout mouse that expresses human MASP-2 andhuman immunoglobulins.

Materials and Methods:

A MASP-2−/− mouse was generated as described in Example 1. A mouse wasthen constructed that expresses human MASP-2 as described in Example 3.A homozygous MASP-2−/− mouse and a MASP-2−/− mouse expressing humanMASP-2 are each crossed with a mouse derived from an embryonic stem cellline engineered to contain targeted disruptions of the endogenousimmunoglobulin heavy chain and light chain loci and expression of atleast a segment of the human immunoglobulin locus. Preferably, thesegment of the human immunoglobulin locus includes unrearrangedsequences of heavy and light chain components. Both inactivation ofendogenous immunoglobulin genes and introduction of exogenousimmunoglobulin genes can be achieved by targeted homologousrecombination. The transgenic mammals resulting from this process arecapable of functionally rearranging the immunoglobulin componentsequences and expressing a repertoire of antibodies of various isotypesencoded by human immunoglobulin genes, without expressing endogenousimmunoglobulin genes. The production and properties of mammals havingthese properties is described, for example see Thomson, A. D., Nature148:1547-1553, 1994, and Sloane, B. F., Nature Biotechnology 14:826,1996. Genetically engineered strains of mice in which the mouse antibodygenes are inactivated and functionally replaced with human antibodygenes is commercially available (e.g., XenoMouse®, available fromAbgenix, Fremont Calif.). The resulting offspring mice are capable ofproducing human MoAb against human MASP-2 that are suitable for use inhuman therapy.

Example 10

This example describes the generation and production of humanized murineanti-MASP-2 antibodies and antibody fragments.

A murine anti-MASP-2 monoclonal antibody is generated in Male A1J miceas described in Example 7. The murine antibody is then humanized asdescribed below to reduce its immunogenicity by replacing the murineconstant regions with their human counterparts to generate a chimericIgG and Fab fragment of the antibody, which is useful for inhibiting theadverse effects of MASP-2-dependent complement activation in humansubjects in accordance with the present invention.

1. Cloning of anti-MASP-2 variable region genes from murine hybridomacells. Total RNA is isolated from the hybridoma cells secretinganti-MASP-2 MoAb (obtained as described in Example 7) using RNAzolfollowing the manufacturer's protocol

(Biotech, Houston, Tex.). First strand cDNA is synthesized from thetotal RNA using oligo dT as the primer. PCR is performed using theimmunoglobulin constant C region-derived 3′ primers and degenerateprimer sets derived from the leader peptide or the first frameworkregion of murine V_(H) or V_(K) genes as the 5′ primers. Anchored PCR iscarried out as described by Chen and Platsucas (Chen, P. F., Scand. J.Immunol. 35:539-549, 1992). For cloning the V_(K) gene, double-strandedcDNA is prepared using a Notl-MAK1 primer(5′-TGCGGCCGCTGTAGGTGCTGTCTTT-3′ SEQ ID NO:38). Annealed adaptors AD1(5′-GGAATTCACTCGTTATTCTCGGA-3′ SEQ ID NO:39) and AD2(5′-TCCGAGAATAACGAGTG-3′ SEQ ID NO:40) are ligated to both 5′ and 3′termini of the double-stranded cDNA. Adaptors at the 3′ ends are removedby Notl digestion. The digested product is then used as the template inPCR with the AD1 oligonucleotide as the 5′ primer and MAK2(5′-CATTGAAAGCTTTGGGGTAGAAGTTGTTC-3′ SEQ ID NO:41) as the 3′ primer. DNAfragments of approximately 500 bp are cloned into pUC19. Several clonesare selected for sequence analysis to verify that the cloned sequenceencompasses the expected murine immunoglobulin constant region. TheNotl-MAK1 and MAK2 oligonucleotides are derived from the V_(K) regionand are 182 and 84 bp, respectively, downstream from the first base pairof the C kappa gene. Clones are chosen that include the complete V_(K)and leader peptide.

For cloning the V_(H) gene, double-stranded cDNA is prepared using theNot1 MAG1 primer (5′-CGCGGCCGCAGCTGCTCAGAGTGTAGA-3′ SEQ ID NO:42).Annealed adaptors AD1 and AD2 are ligated to both 5′ and 3′ termini ofthe double-stranded cDNA. Adaptors at the 3′ ends are removed by Notldigestion. The digested product are used as the template in PCR with theAD1 oligonucleotide and MAG2 (5′-CGGTAAGCTTCACTGGCTCAGGGAAATA-3′ SEQ IDNO:43) as primers. DNA fragments of 500 to 600 bp in length are clonedinto pUC19. The Not1-MAG1 and MAG2 oligonucleotides are derived from themurine Cγ.7.1 region, and are 180 and 93 bp, respectively, downstreamfrom the first bp of the murine Cγ.7.1 gene. Clones are chosen thatencompass the complete V_(H) and leader peptide.

2. Construction of Expression Vectors for Chimeric MASP-2 IgG and Fab.

The cloned V_(H) and V_(K) genes described above are used as templatesin a PCR reaction to add the Kozak consensus sequence to the 5′ end andthe splice donor to the 3′ end of the nucleotide sequence. After thesequences are analyzed to confirm the absence of PCR errors, the V_(H)and V_(K) genes are inserted into expression vector cassettes containinghuman C.γ1 and C. kappa respectively, to give pSV2neoV_(H)-huCyl andpSV2neoV-huCy. CsCl gradient-purified plasmid DNAs of the heavy- andlight-chain vectors are used to transfect COS cells by electroporation.After 48 hours, the culture supernatant is tested by ELISA to confirmthe presence of approximately 200 ng/ml of chimeric IgG. The cells areharvested and total RNA is prepared. First strand cDNA is synthesizedfrom the total RNA using oligo dT as the primer. This cDNA is used asthe template in PCR to generate the Fd and kappa DNA fragments. For theFd gene, PCR is carried out using5′-AAGAAGCTTGCCGCCACCATGGATTGGCTGTGGAACT-3′ (SEQ ID NO:44) as the 5′primer and a CH1-derived 3′ primer(5′-CGGGATCCTCAAACTTTCTTGTCCACCTTGG-3′ SEQ ID NO:45). The DNA sequenceis confirmed to contain the complete V_(H) and the CH1 domain of humanIgG1. After digestion with the proper enzymes, the Fd DNA fragments areinserted at the HindIII and BamHI restriction sites of the expressionvector cassette pSV2dhfr-TUS to give pSV2dhfrFd. The pSV2 plasmid iscommercially available and consists of DNA segments from varioussources: pBR322 DNA (thin line) contains the pBR322 origin of DNAreplication (pBR ori) and the lactamase ampicillin resistance gene(Amp); SV40 DNA, represented by wider hatching and marked, contains theSV40 origin of DNA replication (SV40 ori), early promoter (5′ to thedhfr and neo genes), and polyadenylation signal (3′ to the dhfr and neogenes). The SV40-derived polyadenylation signal (pA) is also placed atthe 3′ end of the Fd gene.

For the kappa gene, PCR is carried out using5′-AAGAAAGCTTGCCGCCACCATGTTCTCACTAGCTCT-3′ (SEQ ID NO:46) as the 5′primer and a C_(K)-derived 3′ primer (5′-CGGGATCCTTCTCCCTCTAACACTCT-3′SEQ ID NO:47). DNA sequence is confirmed to contain the complete V_(K)and human C_(K) regions. After digestion with proper restrictionenzymes, the kappa DNA fragments are inserted at the HindIII and BamHIrestriction sites of the expression vector cassette pSV2neo-TUS to givepSV2neoK. The expression of both Fd and .kappa genes are driven by theHCMV-derived enhancer and promoter elements. Since the Fd gene does notinclude the cysteine amino acid residue involved in the inter-chaindisulfide bond, this recombinant chimeric Fab contains non-covalentlylinked heavy- and light-chains. This chimeric Fab is designated as cFab.

To obtain recombinant Fab with an inter-heavy and light chain disulfidebond, the above Fd gene may be extended to include the coding sequencefor additional 9 amino acids (EPKSCDKTH SEQ ID NO:48) from the hingeregion of human IgG1. The BstEII-BamHI DNA segment encoding 30 aminoacids at the 3′ end of the Fd gene may be replaced with DNA segmentsencoding the extended Fd, resulting in pSV2dhfrFd/9aa.

3. Expression and Purification of Chimeric Anti-MASP-2 IgG

To generate cell lines secreting chimeric anti-MASP-2 IgG, NSO cells aretransfected with purified plasmid DNAs of pSV2neoV_(H)-huC.γ1 andpSV2neoV-huC kappa by electroporation. Transfected cells are selected inthe presence of 0.7 mg/ml G418. Cells are grown in a 250 ml spinnerflask using serum-containing medium.

Culture supernatant of 100 ml spinner culture is loaded on a 10-mlPROSEP-A column (Bioprocessing, Inc., Princeton, N.J.). The column iswashed with 10 bed volumes of PBS. The bound antibody is eluted with 50mM citrate buffer, pH 3.0. Equal volume of 1 M Hepes, pH 8.0 is added tothe fraction containing the purified antibody to adjust the pH to 7.0.Residual salts are removed by buffer exchange with PBS by Milliporemembrane ultrafiltration (M.W. cut-off: 3,000). The proteinconcentration of the purified antibody is determined by the BCA method(Pierce).

4. Expression and Purification of Chimeric Anti-MASP-2 Fab

To generate cell lines secreting chimeric anti-MASP-2 Fab, CHO cells aretransfected with purified plasmid DNAs of pSV2dhfrFd (or pSV2dhfrFd/9aa)and pSV2neokappa, by electroporation. Transfected cells are selected inthe presence of G418 and methotrexate. Selected cell lines are amplifiedin increasing concentrations of methotrexate. Cells are single-cellsubcloned by limiting dilution. High-producing single-cell subclonedcell lines are then grown in 100 ml spinner culture using serum-freemedium.

Chimeric anti-MASP-2 Fab is purified by affinity chromatography using amouse anti-idiotypic MoAb to the MASP-2 MoAb. An anti-idiotypic MASP-2MoAb can be made by immunizing mice with a murine anti-MASP-2 MoAbconjugated with keyhole limpet hemocyanin (KLH) and screening forspecific MoAb binding that can be competed with human MASP-2. Forpurification, 100 ml of supernatant from spinner cultures of CHO cellsproducing cFab or cFab/9aa are loaded onto the affinity column coupledwith an anti-idiotype MASP-2 MoAb. The column is then washed thoroughlywith PBS before the bound Fab is eluted with 50 mM diethylamine, pH11.5. Residual salts are removed by buffer exchange as described above.The protein concentration of the purified Fab is determined by the BCAmethod (Pierce).

The ability of the chimeric MASP-2 IgG, cFab, and cFAb/9aa to inhibitMASP-2-dependent complement pathways may be determined by using theinhibitory assays described in Example 2.

Example 11

This example describes an in vitro C4 cleavage assay used as afunctional screen to identify MASP-2 inhibitory agents capable ofblocking MASP-2-dependent complement activation via L-ficolin/P35,H-ficolin, M-ficolin or mannan.

C4 Cleavage Assay: A C4 cleavage assay has been described by Petersen,S. V., et al., J. Immunol. Methods 257:107, 2001, which measures lectinpathway activation resulting from lipoteichoic acid (LTA) from S. aureuswhich binds L-ficolin.

Reagents: Formalin-fixed S. aureous (DSM20233) is prepared as follows:bacteria is grown overnight at 37° C. in tryptic soy blood medium,washed three times with PBS, then fixed for 1 h at room temperature inPBS/0.5% formalin, and washed a further three times with PBS, beforebeing resuspended in coating buffer (15 mM Na₂Co₃, 35 mM NaHCO₃, pH9.6).

Assay: The wells of a Nunc MaxiSorb microtiter plate (Nalgene NuncInternational, Rochester, N.Y.) are coated with: 100 μl offormalin-fixed S. aureus DSM20233 (OD₅₅₀=0.5) in coating buffer with 1ug of L-ficolin in coating buffer. After overnight incubation, wells areblocked with 0.1% human serum albumin (HSA) in TBS (10 mM Tris-HCl, 140mM NaCl, pH 7.4), then are washed with TBS containing 0.05% Tween 20 and5 mM CaCl₂ (wash buffer). Human serum samples are diluted in 20 mMTris-HCl, 1 M NaCl, 10 mM CaCl₂, 0.05% Triton X-100, 0.1% HSA, pH 7.4,which prevents activation of endogenous C4 and dissociates the C1complex (composed of C1q, C1r and C1s). MASP-2 inhibitory agents,including anti-MASP-2 MoAbs and inhibitory peptides are added to theserum samples in varying concentrations. The diluted samples are addedto the plate and incubated overnight at 4° C. After 24 hours, the platesare washed thoroughly with wash buffer, then 0.1 μg of purified human C4(obtained as described in Dodds, A. W., Methods Enzymol. 223:46, 1993)in 100 μl of 4 mM barbital, 145 mM NaCl, 2 mM CaCl₂, 1 mM MgCl₂, pH 7.4is added to each well. After 1.5 h at 37° C., the plates are washedagain and C4b deposition is detected using alkalinephosphatase-conjugated chicken anti-human C4c (obtained fromImmunsystem, Uppsala, Sweden) and measured using the colorimetricsubstrate p-nitrophenyl phosphate.

C4 Assay on mannan: The assay described above is adapted to measurelectin pathway activation via MBL by coating the plate with LSP andmannan prior to adding serum mixed with various MASP-2 inhibitoryagents.

C4 assay on H-ficolin (Hakata Ag): The assay described above is adaptedto measure lectin pathway activation via H-ficolin by coating the platewith LPS and H-ficolin prior to adding serum mixed with various MASP-2inhibitory agents.

Example 12

The following assay demonstrates the presence of classical pathwayactivation in wild-type and MASP-2−/− mice.

Methods: Immune complexes were generated in situ by coating microtiterplates (Maxisorb, Nunc, cat. No. 442404, Fisher Scientific) with 0.1%human serum albumin in 10 mM Tris, 140 mM NaCl, pH 7.4 for 1 hours atroom temperature followed by overnight incubation at 4° C. with sheepanti whole serum antiserum (Scottish Antibody Production Unit, Carluke,Scotland) diluted 1:1000 in TBS/tween/Ca²⁺. Serum samples were obtainedfrom wild-type and MASP-2−/− mice and added to the coated plates.Control samples were prepared in which C1q was depleted from wild-typeand MASP-2−/− serum samples. C1q-depleted mouse serum was prepared usingprotein-A-coupled Dynabeads (Dynal Biotech, Oslo, Norway) coated withrabbit anti-human C1q IgG (Dako, Glostrup, Denmark), according to thesupplier's instructions. The plates were incubated for 90 minutes at 37°C. Bound C3b was detected with a polyclonal anti-human-C3c Antibody(Dako A 062) diluted in TBS/tw/ Ca⁺⁺ at 1:1000. The secondary antibodyis goat anti-rabbit IgG.

Results: FIG. 9 shows the relative C3b deposition levels on platescoated with IgG in wild-type serum, MASP-2−/− serum, C1q-depletedwild-type and C1q-depleted MASP-2−/− serum. These results demonstratethat the classical pathway is intact in the MASP-2−/− mouse strain.

Example 13

The following assay is used to test whether a MASP-2 inhibitory agentblocks the classical pathway by analyzing the effect of a MASP-2inhibitory agent under conditions in which the classical pathway isinitiated by immune complexes.

Methods: To test the effect of a MASP-2 inhibitory agent on conditionsof complement activation where the classical pathway is initiated byimmune complexes, triplicate 50 μl samples containing 90% NHS areincubated at 37° C. in the presence of 10 μg/ml immune complex (IC) orPBS, and parallel triplicate samples (+/−IC) are also included whichcontain 200 nM anti-properdin monoclonal antibody during the 37° C.incubation. After a two hour incubation at 37° C., 13 mM EDTA is addedto all samples to stop further complement activation and the samples areimmediately cooled to 5° C. The samples are then stored at −70° C. priorto being assayed for complement activation products (C3a and sC5b-9)using ELISA kits (Quidel, Catalog Nos. A015 and A009) following themanufacturer's instructions.

Example 14

This example demonstrates that the lectin-dependent MASP-2 complementactivation system is activated in the ischemia/reperfusion phasefollowing abdominal aortic aneurysm repair.

Experimental Rationale and Design: Patients undergoing abdominal aorticaneurysm (AAA) repair are subject to an ischemia-reperfusion injury,which is largely mediated by complement activation. We investigated therole of the MASP-2-dependent lectin pathway of complement activation inischemia-reperfusion injury in patients undergoing AAA repair. Theconsumption of mannan-binding lectin (MBL) in serum was used to measurethe amount of MASP-2-dependent lectin pathway activation that occurredduring reperfusion.

Patient Serum Sample Isolation: A total of 23 patients undergoingelective infrarenal AAA repair and 8 control patients undergoing majorabdominal surgery were included in this study.

For the patients under going AAA repair, systemic blood samples weretaken from each patient's radial artery (via an arterial line) at fourdefined time points during the procedure: time point 1: induction ofanaesthesia; time point 2: just prior to aortic clamping; time point 3:just prior to aortic clamp removal; and time point 4: duringreperfusion.

For the control patients undergoing major abdominal surgery, systemicblood samples were taken at induction of anaesthesia and at two hoursafter the start of the procedure.

Assay for levels of MBL: Each patient plasma sample was assayed forlevels of mannan-binding lectin (MBL) using ELISA techniques.

Results: The results of this study are shown in FIG. 10, which presentsa graph showing the mean percentage change in MBL levels (y axis) ateach of the various time points (x axis). Starting values for MBL are100%, with relative decreases shown thereafter. As shown in FIG. 10, AAApatients (n=23) show a significant decrease in plasma MBL levels,averaging an approximate 41% decrease at time of ischemia/reperfusionfollowing AAA. In contrast, in control patients (n=8) undergoing majorabdominal surgery only a minor consumption of MBL was observed in theplasma samples.

The data presented provides a strong indication that theMASP-2-dependent lectin pathway of the complement system is activated inthe ischemia/reperfusion phase following AAA repair. The decrease in MBLlevels appears to be associated with ischaemia-reperfusion injurybecause the MBL levels drop significantly and rapidly when the clampedmajor vessel is reperfused after the end of the operation. In contrast,control sera of patients undergoing major abdominal surgery without amajor ischemia-reperfusion insult only show a slight decrease in MBLplasma levels. In view of the well-established contribution ofcomplement activation in reperfusion injury, we conclude that activationof the MASP-2-dependent lectin pathway on ischemic endothelial cells isa major factor in the pathology of ischemia/reperfusion injury.Therefore, a specific transient blockade or reduction in theMASP-2-dependent lectin pathway of complement activation would beexpected to have a significant beneficial therapeutic impact to improvethe outcome of clinical procedures and diseases that involve a transientischemic insult, e.g., myocardial infarction, gut infarction, burns,transplantation and stroke.

Example 15

This example describes the use of the MASP-2−/− strain as an animalmodel for testing MASP-2 inhibitory agents useful to treat RheumatoidArthritis.

Background and Rationale: Murine Arthritis Model: K/BxN T cell receptor(TCR) transgenic (tg) mice, is a recently developed model ofinflammatory arthritis (Kouskoff, V., et al., Cell 87:811-822, 1996;Korganow, A. S., et al., Immunity 10:451-461, 1999; Matsumoto, I., etal., Science 286:1732-1735, 1999; Maccioni M. et al., J. Exp. Med.195(8):1071-1077, 2002). The K/BxN mice spontaneously develop anautoimmune disease with most of the clinical, histological andimmunological features of RA in humans (Ji, H., et al., Immunity16:157-168, 2002). The murine disorder is joint specific, but isinitiated then perpetuated by T, then B cell autoreactivity toglucose-6-phosphate isomerase (“GPI”), a ubiquitously expressed antigen.Further, transfer of serum (or purified anti-GPI Igs) from arthriticK/BxN mice into healthy animals provokes arthritis within several days.It has also been shown that polyclonal anti-GPI antibodies or a pool ofanti-GPI monoclonal antibodies of the IgG1 isotype induce arthritis wheninjected into healthy recipients (Maccioni et al., 2002). The murinemodel is relevant to human RA, because serum from RA patients has alsobeen found to contain anti-GPI antibodies, which is not found in normalindividuals. A C5-deficient mouse was tested in this system and found toblock the development of arthritis (Ji, H., et al., 2002, supra). Therewas also strong inhibition of arthritis in C3 null mice, implicating thealternative pathway, however, MBP-A null mice did develop arthritis. Inmice however, the presence of MBP-C may compensate for the loss ofMBP-A.

Based on the observations described herein that MASP-2 plays anessential role in the initiation of both the lectin and alternativepathways, the K/BxN arthritic model is useful to screen for MASP-2inhibitory agents that are effective for use as a therapeutic agents totreat RA.

Methods: Serum from arthritic K/BxN mice is obtained at 60 days of age,pooled and injected (150-200 μl i.p.) into MASP-2−/− recipients(obtained as described in Example 1); and control littermates with orwithout MASP-2 inhibitory agents (MoAb, inhibitory peptides and the likeas described herein) at days 0 and 2. A group of normal mice are alsopretreated with a MASP-2 inhibitory agent for two days prior toreceiving the injection of serum. A further group of mice receive aninjection of serum at day 0, followed by a MASP-2 inhibitory agent atday 6. A clinical index is evaluated over time with one point scored foreach affected paw, ¹/₂ point scored for a paw with only mild swelling.Ankle thickness is also measured by a caliper (thickness is defined asthe difference from day 0 measurement).

Example 16

This example describes an assay for inhibition of complement-mediatedtissue damage in an ex vivo model of rabbit hearts perfused with humanplasma.

Background and Rationale: Activation of the complement systemcontributes to hyperacute rejection of xenografts. Previous studies haveshown that hyperacute rejection can occur in the absence of anti-donorantibodies via activation of the alternative pathway (Johnston, P. S.,et al., Transplant Proc. 23:877-879, 1991).

Methods: To determine whether isolated anti-MASP-2 inhibitory agentssuch as anti-MASP-2 antibodies obtained as described in Example 7 areable to inhibit complement pathway in tissue damage, the anti-MASP-2MoAbs and antibody fragments may be tested using an ex vivo model inwhich isolated rabbit hearts are perfused with diluted human plasma.This model was previously shown to cause damage to the rabbit myocardiumdue to the activation of the alternative complement pathway (Gralinski,M. R., et al., Immunopharmacology 34:79-88, 1996).

Example 17

This example describes an assay that measures neutrophil activationwhich is useful as a measure of an effective dose of a MASP-2 inhibitoryagent for the treatment of conditions associated with thelectin-dependent pathway in accordance with the methods of theinvention.

Methods: A method for measuring neutrophil elastase has been describedin Gupta-Bansal, R., et al., Molecular Immunol. 37:191-201, 2000.Briefly, the complex of elastase and serum α1-antitrypsin is measuredwith a two-site sandwich assay that utilizes antibodies against bothelastase and α₁-antitrypsin. Polystyrene microtiter plates are coatedwith a 1:500 dilution of anti-human elastase antibody (The Binding Site,Birmingham, UK) in PBS overnight at 4° C. After aspirating the antibodysolution, wells are blocked with PBS containing 0.4% HAS for 2 h at roomtemperature. Aliquots (100 μl) of plasma samples that are treated withor without a MASP-2 inhibitory agent are added to the wells. Following a2 h incubation at room temperature, the wells are extensively rinsedwith PBS. Bound elastase-α₁-antitrypsin complex is detected by theaddition of a 1:500 dilution of peroxidase conjugated-α₁-antitrypsinantibody in blocking solution that is allowed to incubate for 1 h atroom temperature. After washing the plate with PBS, 100 μl aliquots ofTMB substrate are added. The reaction of TMB is quenched by the additionof 100 μl of phosphoric acid, and the plate is read at 450 nm in amicroplate reader.

Example 18

This example describes an animal model for testing MASP-2 inhibitoryagents useful to treat myocardial ischemia/reperfusion.

Methods: A myocardial ischemia-reperfusion model has been described byVakeva et al., Circulation 97:2259-2267, 1998, and Jordan et al.,Circulation 104(12):1413-1418, 2001. The described model may be modifiedfor use in MASP-2−/− and MASP-2+/+ mice as follows. Briefly, adult malemice are anesthetized. Jugular vein and trachea are cannulated andventilation is maintained with 100% oxygen with a rodent ventilatoradjusted to maintain exhaled CO₂ between 3.5% and 5%. A left thoracotomyis performed and a suture is placed 3 to 4 mm from the origin of theleft coronary artery. Five minutes before ischemia, animals are given aMASP-2 inhibitory agent, such as anti-MASP-2 antibodies (e.g., in adosage range of between 0.01 to 10 mg/kg). Ischemia is then initiated bytightening the suture around the coronary artery and maintained for 30minutes, followed by four hours of reperfusion. Sham-operated animalsare prepared identically without tightening the suture.

Analysis of Complement C3 Deposition: After reperfusion, samples forimmunohistochemistry are obtained from the central region of the leftventricle, fixed and frozen at -80° C. until processed. Tissue sectionsare incubated with an HRP-conjugated goat anti-rat C3 antibody. Tissuesections are analyzed for the presence of C3 staining in the presence ofanti-MASP-2 inhibitory agents as compared with sham-operated controlanimals and MASP-2−/− animals to identify MASP-2 inhibitory agents thatreduce C3 deposition in vivo.

Example 19

This example describes the use of the MASP-2−/− strain as an animalmodel for testing MASP-2 inhibitory agents for the ability to protecttransplanted tissue from ischemia/reperfusion injury.

Background/Rationale: It is known that ischemia/reperfusion injuryoccurs in a donor organ during transplantation. The extent of tissuedamage is related to the length of ischemia and is mediated bycomplement, as demonstrated in various models of ischemia and throughthe use of complement inhibiting agents such as soluble receptor type 1(CR1) (Weisman et al., Science 249:146-151, 1990; Mulligan et al., J.Immunol. 148:1479-1486, 1992; Pratt et al., Am. J. Path.163(4):1457-1465, 2003). An animal model for transplantation has beendescribed by Pratt et al., Am. J. Path. 163(4):1457-1465, which may bemodified for use with the MASP-2−/− mouse model and/or for use as aMASP-2+/+ model system in which to screen MASP-2 inhibitory agents forthe ability to protect transplanted tissue from ischemia/reperfusioninjury. The flushing of the donor kidney with perfusion fluid prior totransplantation provides an opportunity to introduce anti-MASP-2inhibitory agents into the donor kidney.

Methods: MASP-2−/− and/or MASP-2+/+mice are anesthetized. The left donorkidney is dissected and the aorta is ligated cephalad and caudad to therenal artery. A portex tube catheter (Portex Ltd, Hythe, UK) is insertedbetween the ligatures and the kidney is perfused with 5 ml of SoltranKidney Perfusion Solution (Baxter Health Care, UK) containing MASP-2inhibitory agents such as anti-MASP-2 monoclonal antibodies (in a dosagerange of from .01 mg/kg to 10 mg/kg) for a period of at least 5 minutes.Renal transplantation is then performed and the mice are monitored overtime.

Analysis of Transplant Recipients: Kidney transplants are harvested atvarious time intervals and tissue sections are analyzed using anti-C3 todetermine the extent of C3 deposition.

Example 20

This example describes the use of a collagen-induced arthritis (CIA)animal model for testing MASP-2 inhibitory agents useful to treatrheumatoid arthritis (RA).

Background and Rationale: Collagen-induced arthritis (CIA) represents anautoimmune polyarthritis inducible in susceptible strains of rodents andprimates after immunization with native type II collagen and isrecognized as a relevant model for human rheumatoid arthritis (RA) (seeCourtney et al., Nature 283:666 (1980); Trenthan et al., J. Exp. Med.146:857 (1977)). Both RA and CIA are characterized by jointinflammation, pannus formation and cartilage and bone erosion. The CIAsusceptible murine strain DBA/1LacJ is a developed model of CIA in whichmice develop clinically severe arthritis after immunization with Bovinetype II collagen (Wang et al., J. Immunol. 164:4340-4347 (2000). AC5-deficient mouse strain was crossed with DBA/1LacJ and the resultingstrain was found to be resistant to the development of CIA arthritis(Wang et al., 2000, supra).

Based on the observations described herein that MASP-2 plays anessential role in the initiation of both the lectin and alternativepathways, the CIA arthritic model is useful to screen for MASP-2inhibitory agents that are effective for use as therapeutic agents totreat RA.

Methods: A MASP-2−/− mouse is generated as described in Example 1. TheMASP-2−/− mouse is then crossed with a mouse derived from the DBA/1LacJstrain (The Jackson Laboratory). F1 and subsequent offspring areintercrossed to produce homozygous MASP-2−/− in the DBA/1LacJ line.

Collagen immunization is carried out as described in Wang et al., 2000,supra. Briefly, wild-type DBA/1LacJ mice and MASP-2−/− DBA/1LacJ miceare immunized with Bovine type II collagen (BCII) or mouse type IIcollagen (MCII) (obtained from Elastin Products, Owensville, Mo.),dissolved in 0.01 M acetic acid at a concentration of 4 mg/ml. Eachmouse is injected intradermally at the base of the tail with 200 ug CIIand 100 ug mycobacteria. Mice are re-immunized after 21 days and areexamined daily for the appearance of arthritis. An arthritic index isevaluated over time with respect to the severity of arthritis in eachaffected paw.

MASP-2 inhibitory agents are screened in the wild-type DBA/1LacJ CIAmice by injecting a MASP-2 inhibitory agent such as anti-MASP-2monoclonal antibodies (in a dosage range of from .01 mg/kg to 10 mg/kg)at the time of collagen immunization, either systemically, or locally atone or more joints and an arthritic index is evaluated over time asdescribed above. Anti-hMASP-2 monoclonal antibodies as therapeuticagents can be easily evaluated in a MASP-2−/−, hMASP-+/+ knock-inDBA/1LacJ CIA mouse model.

Example 21

This example describes the use of a (NZB/W) F₁ animal model for testingMASP-2 inhibitory agents useful to treat immune-complex mediatedglomerulonephritis.

Background and Rationale: New Zealand black x New Zealand white (NZB/W)F1 mice spontaneously develop an autoimmune syndrome with notablesimilarities to human immune-complex mediated glomerulonephritis. TheNZB/W F1 mice invariably succumb to glomerulonephritis by 12 months ofage. As discussed above, it has been demonstrated that complementactivation plays a significant role in the pathogenesis ofimmune-complex mediated glomerulonephritis. It has been further shownthat the administration of an anti-C5 MoAb in the NZB/W F1 mouse modelresulted in significant amelioration of the course ofglomerulonepthritis (Wang et al., Proc. Natl. Acad. Sci. 93:8563-8568(1996)). Based on the observations described herein that MASP-2 plays anessential role in the initiation of both the lectin and alternativepathways, the NZB/W F₁ animal model is useful to screen for MASP-2inhibitory agents that are effective for use as therapeutic agents totreat glomerulonephritis.

Methods: A MASP-2−/− mouse is generated as described in Example 1. TheMASP-2−/− mouse is then separately crossed with a mouse derived bothfrom the NZB and the NZW strains (The Jackson Laboratory). F1 andsubsequent offspring are intercrossed to produce homozygous MASP-2−/− inboth the NZB and NZW genetic backgrounds. To determine the role ofMASP-2 in the pathogenesis of glomerulonephritis in this model, thedevelopment of this disease in F1 individuals resulting from crosses ofeither wild-type NZB x NZW mice or MASP-2−/−NZB x MASP-2−/−NZW mice arecompared. At weekly intervals urine samples will be collected from theMASP-2+/+ and MASP-2−/− F1 mice and urine protein levels monitored forthe presence of anti-DNA antibodies (as described in Wang et al., 1996,supra). Histopathological analysis of the kidneys is also carried out tomonitor the amount of mesangial matrix deposition and development ofglomerulonephritis.

The NZB/W F1 animal model is also useful to screen for MASP-2 inhibitoryagents that are effective for use as therapeutic agents to treatglomerulonephritis. At 18 weeks of age, wild-type NZB/W F1 mice areinjected intraperitoneally with anti-MASP-2 inhibitory agents, such asanti-MASP-2 monoclonal antibodies (in a dosage range of from 0.01 mg/kgto 10 mg/kg) at a frequency of weekly or biweekly. The above-mentionedhistopathological and biochemical markers of glomerulonephritis are usedto evaluate disease development in the mice and to identify usefulMASP-2 inhibitory agents for the treatment of this disease.

Example 22

This example describes the use of a tubing loop as a model for testingMASP-2 inhibitory agents useful to prevent tissue damage resulting fromextracorporeal circulation (ECC) such as a cardiopulmonary bypass (CPB)circuit.

Background and Rationale: As discussed above, patients undergoing ECCduring CPB suffer a systemic inflammatory reaction, which is partlycaused by exposure of blood to the artificial surfaces of theextracorporeal circuit, but also by surface-independent factors likesurgical trauma and ischemia-reperfusion injury (Butler, J., et al.,Ann. Thorac. Surg. 55:552-9, 1993; Edmunds, L. H., Ann. Thorac. Surg.66(Suppl):S12-6, 1998; Asimakopoulos, G., Perfusion 14:269-77, 1999). Ithas further been shown that the alternative complement pathway plays apredominant role in complement activation in CPB circuits, resultingfrom the interaction of blood with the artificial surfaces of the CPBcircuits (see Kirklin et al., 1983, 1986, discussed supra). Therefore,based on the observations described herein that MASP-2 plays anessential role in the initiation of both the lectin and alternativepathways, the tubing loop model is useful to screen for MASP-2inhibitory agents that are effective for use as therapeutic agents toprevent or treat an extracorporeal exposure-triggered inflammatoryreaction.

Methods: A modification of a previously described tubing loop model forcardiopulmonary bypass circuits is utilized (see Gong et al., J.Clinical Immunol. 16(4):222-229 (1996)) as described in Gupta-Bansal etal., Molecular Immunol. 37:191-201 (2000). Briefly, blood is freshlycollected from a healthy subject in a 7 ml vacutainer tube (containing 7units of heparin per ml of whole blood). Polyethylene tubing similar towhat is used during CPB procedures (e.g., I.D. 2.92 mm; O.D. 3.73 mm,length: 45 cm) is filled with 1 ml of blood and closed into a loop witha short piece of silicone tubing. A control tubing containingheparinized blood with 10 mM EDTA was included in the study as abackground control. Sample and control tubings were rotated verticallyin a water bath for 1 hour at 37° C. After incubation, the blood sampleswere transferred into 1.7 ml microfuge tubes containing EDTA, resultingin a final concentration of 20 mM EDTA. The samples were centrifuged andthe plasma was collected. MASP-2 inhibitory agents, such as anti-MASP-2antibodies are added to the heparinized blood immediately beforerotation. The plasma samples are then subjected to assays to measure theconcentration C3a and soluble C5b-9 as described in Gupta-Bansal et al.,2000, supra.

Example 23

This example describes the use of a rodent caecal ligation and puncture(CLP) model system for testing MASP-2 inhibitory agents useful to treatsepsis or a condition resulting from sepsis, including severe sepsis,septic shock, acute respiratory distress syndrome resulting from sepsisand systemic inflammatory response syndrome.

Background and Rationale: As discussed above, complement activation hasbeen shown in numerous studies to have a major role in the pathogenesisof sepsis (see Bone, R. C., Annals. Internal. Med. 115:457-469, 1991).The CLP rodent model is a recognized model that mimics the clinicalcourse of sepsis in humans and is considered to be a reasonablesurrogate model for sepsis in humans (see Ward, P., Nature ReviewImmunology 4:133-142 (2004). A recent study has shown that treatment ofCLP animals with anti-05a antibodies resulted in reduced bacteremia andgreatly improved survival Huber-Lang et al., J. of Immunol.169:3223-3231 (2002). Therefore, based on the observations describedherein that MASP-2 plays an essential role in the initiation of both thelectin and alternative pathways, the CLP rodent model is useful toscreen for MASP-2 inhibitory agents that are effective for use astherapeutic agents to prevent or treat sepsis or a condition resultingfrom sepsis.

Methods: The CLP model is adapted from the model described in Huber-Langet al., 2004, supra as follows. MASP-2−/− and MASP-2+/+animals areanesthetized. A 2 cm midline abdominal incision is made and the cecum istightly ligated below the ileocecal valve, avoiding bowel obstruction.The cecum is then punctured through and through with a 21-gauge needle.The abdominal incision was then closed in layers with silk suture andskin clips (Ethicon, Summerville, N.J.). Immediately after CLP, animalsreceive an injection of a MASP-2 inhibitory agent such as anti-MASP-2monoclonal antibodies (in a dosage range of from 0.01 mg/kg to 10mg/kg). Anti-hMASP-2 monoclonal antibodies as therapeutic agents can beeasily evaluated in a MASP-2−/−, hMASP-+/+ knock-in CLP mouse model. Theplasma of the mice are then analyzed for levels of complement-derivedanaphylatoxins and respiratory burst using the assays described inHuber-Lang et al., 2004, supra.

Example 24

This example describes the identification of high affinity anti-MASP-2Fab2 antibody fragments that block MASP-2 activity.

Background and rationale: MASP-2 is a complex protein with many separatefunctional domains, including: binding site(s) for MBL and ficolins, aserine protease catalytic site, a binding site for proteolytic substrateC2, a binding site for proteolytic substrate C4, a MASP-2 cleavage sitefor autoactivation of MASP-2 zymogen, and two Ca⁺⁺ binding sites. Fab2antibody fragments were identified that bind with high affinity toMASP-2, and the identified Fab2 fragments were tested in a functionalassay to determine if they were able to block MASP-2 functionalactivity.

To block MASP-2 functional activity, an antibody or Fab2 antibodyfragment must bind and interfere with a structural epitope on MASP-2that is required for MASP-2 functional activity. Therefore, many or allof the high affinity binding anti-MASP-2 Fab2s may not inhibit MASP-2functional activity unless they bind to structural epitopes on MASP-2that are directly involved in MASP-2 functional activity.

A functional assay that measures inhibition of lectin pathway C3convertase formation was used to evaluate the “blocking activity” ofanti-MASP-2 Fab2s. It is known that the primary physiological role ofMASP-2 in the lectin pathway is to generate the next functionalcomponent of the lectin-mediated complement pathway, namely the lectinpathway C3 convertase. The lectin pathway C3 convertase is a criticalenzymatic complex (C4bC2a) that proteolytically cleaves C3 into C3a andC3b. MASP-2 is not a structural component of the lectin pathway C3convertase (C4bC2a); however, MASP-2 functional activity is required inorder to generate the two protein components (C4b, C2a) that comprisethe lectin pathway C3 convertase. Furthermore, all of the separatefunctional activities of MASP-2 listed above appear to be required inorder for MASP-2 to generate the lectin pathway C3 convertase. For thesereasons, a preferred assay to use in evaluating the “blocking activity”of anti-MASP-2 Fab2s is believed to be a functional assay that measuresinhibition of lectin pathway C3 convertase formation. Generation of HighAffinity Fab2s: A phage display library of human variable light andheavy chain antibody sequences and automated antibody selectiontechnology for identifying Fab2s that react with selected ligands ofinterest was used to create high affinity Fab2s to rat MASP-2 protein(SEQ ID NO:55). A known amount of rat MASP-2 (˜1 mg, >85% pure) proteinwas utilized for antibody screening. Three rounds of amplification wereutilized for selection of the antibodies with the best affinity.Approximately 250 different hits expressing antibody fragments werepicked for ELISA screening. High affinity hits were subsequentlysequenced to determine uniqueness of the different antibodies.

Fifty unique anti-MASP-2 antibodies were purified and 250 μg of eachpurified Fab2 antibody was used for characterization of MASP-2 bindingaffinity and complement pathway functional testing, as described in moredetail below.

Assays Used to Evaluate the Inhibitory (blocking) Activity ofAnti-MASP-2 Fab2s

1. Assay to Measure Inhibition of Formation of Lectin Pathway C3Convertase:

Background: The lectin pathway C3 convertase is the enzymatic complex(C4bC2a) that proteolytically cleaves C3 into the two potentproinflammatory fragments, anaphylatoxin C3a and opsonic C3b. Formationof C3 convertase appears to a key step in the lectin pathway in terms ofmediating inflammation. MASP-2 is not a structural component of thelectin pathway C3 convertase (C4bC2a); therefore anti-MASP-2 antibodies(or Fab2) will not directly inhibit activity of preexisting C3convertase. However, MASP-2 serine protease activity is required inorder to generate the two protein components (C4b, C2a) that comprisethe lectin pathway C3 convertase. Therefore, anti-MASP-2 Fab2 whichinhibit MASP-2 functional activity (i.e., blocking anti-MASP-2 Fab2)will inhibit de novo formation of lectin pathway C3 convertase. C3contains an unusual and highly reactive thioester group as part of itsstructure. Upon cleavage of C3 by C3 convertase in this assay, thethioester group on C3b can form a covalent bond with hydroxyl or aminogroups on macromolecules immobilized on the bottom of the plastic wellsvia ester or amide linkages, thus facilitating detection of C3b in theELISA assay.

Yeast mannan is a known activator of the lectin pathway. In thefollowing method to measure formation of C3 convertase, plastic wellscoated with mannan were incubated for 30 min at 37° C. with diluted ratserum to activate the lectin pathway. The wells were then washed andassayed for C3b immobilized onto the wells using standard ELISA methods.The amount of C3b generated in this assay is a direct reflection of thede novo formation of lectin pathway C3 convertase. Anti-MASP-2 Fab2s atselected concentrations were tested in this assay for their ability toinhibit C3 convertase formation and consequent C3b generation.

Methods:

96-well Costar Medium Binding plates were incubated overnight at 5° C.with mannan diluted in 50 mM carbonate buffer, pH 9.5 at 1 ug/50Tl/well. After overnight incubation, each well was washed three timeswith 200 Tl PBS. The wells were then blocked with 100 Tl/well of 1%bovine serum albumin in PBS and incubated for one hour at roomtemperature with gentle mixing. Each well was then washed three timeswith 200 Tl of PBS. The anti-MASP-2 Fab2 samples were diluted toselected concentrations in Ca⁺⁺ and Mg⁺⁺ containing GVB buffer (4.0 mMbarbital, 141 mM NaCl, 1.0 mM MgCl₂, 2.0 mM CaCl₂, 0.1% gelatin, pH 7.4)at 5 C. A 0.5% rat serum was added to the above samples at 5 C and 100Tl was transferred to each well. Plates were covered and incubated for30 minutes in a 37 C waterbath to allow complement activation. Thereaction was stopped by transferring the plates from the 37 C waterbathto a container containing an ice-water mix. Each well was washed fivetimes with 200 Tl with PBS-Tween 20 (0.05% Tween 20 in PBS), then washedtwo times with 200 Tl PBS. A 100 Tl/well of 1:10,000 dilution of theprimary antibody (rabbit anti-human C3c, DAKO A0062) was added in PBScontaining 2.0 mg/ml bovine serum albumin and incubated 1 hr at roomtemperature with gentle mixing. Each well was washed 5×200 Tl PBS. 100Tl/well of 1:10,000 dilution of the secondary antibody(peroxidase-conjugated goat anti-rabbit IgG, American Qualex A102PU) wasadded in PBS containing 2.0 mg/ml bovine serum albumin and incubated forone hour at room temperature on a shaker with gentle mixing. Each wellwas washed five times with 200 Tl with PBS. 100 Tl/well of theperoxidase substrate TMB (Kirkegaard & Perry Laboratories) was added andincubated at room temperature for 10 min. The peroxidase reaction wasstopped by adding 100 Tl/well of 1.0 M H₃PO₄ and the _(0D450.) wasmeasured.

2. Assay to Measure Inhibition of MASP-2-Dependent C4 Cleavage

Background: The serine protease activity of MASP-2 is highly specificand only two protein substrates for MASP-2 have been identified; C2 andC4. Cleavage of C4 generates C4a and C4b. Anti-MASP-2 Fab2 may bind tostructural epitopes on MASP-2 that are directly involved in C4 cleavage(e.g., MASP-2 binding site for C4; MASP-2 serine protease catalyticsite) and thereby inhibit the C4 cleavage functional activity of MASP-2.

Yeast mannan is a known activator of the lectin pathway. In thefollowing method to measure the C4 cleavage activity of MASP-2, plasticwells coated with mannan were incubated for 30 minutes at 37 C withdiluted rat serum to activate the lectin pathway. Since the primaryantibody used in this ELISA assay only recognizes human C4, the dilutedrat serum was also supplemented with human C4 (1.0 Tg/ml). The wellswere then washed and assayed for human C4b immobilized onto the wellsusing standard ELISA methods. The amount of C4b generated in this assayis a measure of MASP-2 dependent C4 cleavage activity. Anti-MASP-2 Fab2at selected concentrations were tested in this assay for their abilityto inhibit C4 cleavage. Methods: 96-well Costar Medium Binding plateswere incubated overnight at 5 C with mannan diluted in 50 mM carbonatebuffer, pH 9.5 at 1.0 Tg/50 Tl/well. Each well was washed 3× with 200 TlPBS. The wells were then blocked with 100 Tl/well of 1% bovine serumalbumin in PBS and incubated for one hour at room temperature withgentle mixing. Each well was washed 3× with 200 Tl of PBS. Anti-MASP-2Fab2 samples were diluted to selected concentrations in Ca⁺⁺ and Mg⁺⁺containing GVB buffer (4.0 mM barbital, 141 mM NaCl, 1.0 mM MgCl₂, 2.0mM CaCl₂, 0.1% gelatin, pH 7.4) at 5 C. 1.0 Tg/ml human C4 (Quidel) wasalso included in these samples. 0.5% rat serum was added to the abovesamples at 5 C and 100 Tl was transferred to each well. The plates werecovered and incubated for 30 min in a 37 C waterbath to allow complementactivation. The reaction was stopped by transferring the plates from the37 C waterbath to a container containing an ice-water mix. Each well waswashed 5×200 Tl with PBS-Tween 20 (0.05% Tween 20 in PBS), then eachwell was washed with 2× with 200 Tl PBS. 100 Tl/well of 1:700 dilutionof biotin-conjugated chicken anti-human C4c (Immunsystem AB, Uppsala,Sweden) was added in PBS containing 2.0 mg/ml bovine serum albumin (BSA)and incubated one hour at room temperature with gentle mixing. Each wellwas washed 5×200 Tl PBS. 100 Tl/well of 0.1 Tg/ml ofperoxidase-conjugated streptavidin (Pierce Chemical #21126) was added inPBS containing 2.0 mg/ml BSA and incubated for one hour at roomtemperature on a shaker with gentle mixing. Each well was washed 5×200Tl with PBS. 100 Tl/well of the peroxidase substrate TMB (Kirkegaard &Perry Laboratories) was added and incubated at room temperature for 16min. The peroxidase reaction was stopped by adding 100 Tl/well of 1.0 MH₃PO₄ and the OD₄₅₀ .was measured.

3. Binding Assay of anti-rat MASP-2 Fab2 to ‘Native’ rat MASP-2Background: MASP-2 is usually present in plasma as a MASP-2 dimercomplex that also includes specific lectin molecules (mannose-bindingprotein (MBL) and ficolins).

Therefore, if one is interested in studying the binding of anti-MASP-2Fab2 to the physiologically relevant form of MASP-2, it is important todevelop a binding assay in which the interaction between the Fab2 and‘native’ MASP-2 in plasma is used, rather than purified recombinantMASP-2. In this binding assay the ‘native’ MASP-2-MBL complex from 10%rat serum was first immobilized onto mannan-coated wells. The bindingaffinity of various anti-MASP-2 Fab2s to the immobilized ‘native’ MASP-2was then studied using a standard ELISA methodology.

Methods: 96-well Costar High Binding plates were incubated overnight at5° C. with mannan diluted in 50 mM carbonate buffer, pH 9.5 at 1 Tg/50Tl/well. Each well was washed 3× with 200 Tl PBS. The wells were blockedwith 100 Tl/well of 0.5% nonfat dry milk in PBST (PBS with 0.05% Tween20) and incubated for one hour at room temperature with gentle mixing.Each well was washed 3× with 200 Tl of TBS/Tween/Ca⁺⁺ Wash Buffer(Tris-buffered saline, 0.05% Tween 20, containing 5.0 mM CaCl₂, pH 7.4.10% rat serum in High Salt Binding Buffer (20 mM Tris, 1.0 M NaCl, 10 mMCaCl₂, 0.05% Triton-X100, 0.1% (w/v) bovine serum albumin, pH 7.4) wasprepared on ice. 100 Tl/well was added and incubated overnight at 5° C.Wells were washed 3× with 200 Tl of TBS/Tween/Ca⁺⁺ Wash Buffer. Wellswere then washed 2× with 200 Tl PBS. 100 Tl/well of selectedconcentration of anti-MASP-2 Fab2 diluted in Ca⁺⁺ and Mg⁺⁺ containingGVB Buffer (4.0 mM barbital, 141 mM NaCl, 1.0 mM MgCl₂, 2.0 mM CaCl₂,0.1% gelatin, pH 7.4) was added and incubated for one hour at roomtemperature with gentle mixing. Each well was washed 5×200 Tl PBS. 100Tl/well of HRP-conjugated goat anti-Fab2 (Biogenesis Cat No 0500-0099)diluted 1:5000 in 2.0 mg/ml bovine serum albumin in PBS was added andincubated for one hour at room temperature with gentle mixing. Each wellwas washed 5×200 Tl PBS. 100 Tl/well of the peroxidase substrate TMB(Kirkegaard & Perry

Laboratories) was added and incubated at room temperature for 70 min.The peroxidase reaction was stopped by adding 100 Tl/well of 1.0 M H₃PO₄and OD₄₅₀. was measured.

Results:

Approximately 250 different Fab2s that reacted with high affinity to therat MASP-2 protein were picked for ELISA screening. These high affinityFab2s were sequenced to determine the uniqueness of the differentantibodies, and 50 unique anti-MASP-2 antibodies were purified forfurther analysis. 250 ug of each purified Fab2 antibody was used forcharacterization of MASP-2 binding affinity and complement pathwayfunctional testing. The results of this analysis is shown below in TABLE6.

TABLE 6 ANTI-MASP-2 FAB2 THAT BLOCK LECTIN PATHWAY COMPLEMENT ACTIVATIONC3 Convertase C4 Cleavage Fab2 antibody # (IC₅₀ (nM) K_(d) IC₅₀ (nM) 880.32 4.1 ND 41 0.35 0.30 0.81 11 0.46 0.86 <2 nM 86 0.53 1.4 ND 81 0.542.0 ND 66 0.92 4.5 ND 57 0.95 3.6 <2 nM 40 1.1 7.2 0.68 58 1.3 2.6 ND 601.6 3.1 ND 52 1.6 5.8 <2 nM 63 2.0 6.6 ND 49 2.8 8.5 <2 nM 89 3.0 2.5 ND71 3.0 10.5 ND 87 6.0 2.5 ND 67 10.0 7.7 ND

As shown above in TABLE 6, of the 50 anti-MASP-2 Fab2s tested, seventeenFab2s were identified as MASP-2 blocking Fab2 that potently inhibit C3convertase formation with IC₅₀ equal to or less than 10 nM Fab2s (a 34%positive hit rate). Eight of the seventeen Fab2s identified have IC₅₀sin the subnanomolar range. Furthermore, all seventeen of the MASP-2blocking Fab2s shown in TABLE 6 gave essentially complete inhibition ofC3 convertase formation in the lectin pathway C3 convertase assay. FIG.11A graphically illustrates the results of the C3 convertase formationassay for Fab2 antibody #11, which is representative of the other Fab2antibodies tested, the results of which are shown in TABLE 6. This is animportant consideration, since it is theoretically possible that a“blocking” Fab2 may only fractionally inhibit MASP-2 function even wheneach MASP-2 molecule is bound by the Fab2.

Although mannan is a known activator of the lectin pathway, it istheoretically possible that the presence of anti-mannan antibodies inthe rat serum might also activate the classical pathway and generate C3bvia the classical pathway C3 convertase. However, each of the seventeenblocking anti-MASP-2 Fab2s listed in this example potently inhibits C3bgeneration (>95%), thus demonstrating the specificity of this assay forlectin pathway C3 convertase.

Binding assays were also performed with all seventeen of the blockingFab2s in order to calculate an apparent K_(d) for each. The results ofthe binding assays of anti-rat MASP-2 Fab2s to native rat MASP-2 for sixof the blocking Fab2s are also shown in TABLE 6. FIG. 11B graphicallyillustrates the results of a binding assay with the Fab2 antibody #11.Similar binding assays were also carried out for the other Fab2s, theresults of which are shown in TABLE 6. In general, the apparent K_(d)sobtained for binding of each of the six Fab2s to ‘native’ MASP-2corresponds reasonably well with the IC₅₀ for the Fab2 in the C3convertase functional assay. There is evidence that MASP-2 undergoes aconformational change from an ‘inactive’ to an ‘active’ form uponactivation of its protease activity (Feinberg et al., EMBO J 22:2348-59(2003); Gal et al., J. Biol. Chem. 280:33435-44 (2005)). In the normalrat plasma used in the C3 convertase formation assay, MASP-2 is presentprimarily in the ‘inactive’ zymogen conformation. In contrast, in thebinding assay, MASP-2 is present as part of a complex with MBL bound toimmobilized mannan; therefore, the MASP-2 would be in the ‘active’conformation (Petersen et al., J. Immunol Methods 257:107-16, 2001).Consequently, one would not necessarily expect an exact correspondencebetween the IC₅₀ and K_(d) for each of the seventeen blocking Fab2tested in these two functional assays since in each assay the Fab2 wouldbe binding a different conformational form of MASP-2. Never-the-less,with the exception of Fab2 #88, there appears to be a reasonably closecorrespondence between the IC₅₀ and apparent Kd for each of the othersixteen Fab2 tested in the two assays (see TABLE 6).

Several of the blocking Fab2s were evaluated for inhibition of MASP-2mediated cleavage of C4. FIG. 11C graphically illustrates the results ofa C4 cleavage assay, showing inhibition with Fab2 #41, with an IC₅₀=0.81nM (see TABLE 6). As shown in FIG. 12, all of the Fab2s tested werefound to inhibit C4 cleavage with IC₅₀s similar to those obtained in theC3 convertase assay (see TABLE 6).

Although mannan is a known activator of the lectin pathway, it istheoretically possible that the presence of anti-mannan antibodies inthe rat serum might also activate the classical pathway and therebygenerate C4b by Cls-mediated cleavage of C4. However, severalanti-MASP-2 Fab2s have been identified which potently inhibit C4bgeneration (>95%), thus demonstrating the specificity of this assay forMASP-2 mediated C4 cleavage. C4, like C3, contains an unusual and highlyreactive thioester group as part of its structure. Upon cleavage of C4by MASP-2 in this assay, the thioester group on C4b can form a covalentbond with hydroxyl or amino groups on macromolecules immobilized on thebottom of the plastic wells via ester or amide linkages, thusfacilitating detection of C4b in the ELISA assay.

These studies clearly demonstrate the creation of high affinity FAB2s torat MASP-2 protein that functionally block both C4 and C3 convertaseactivity, thereby preventing lectin pathway activation.

Example 25

This Example describes the epitope mapping for several of the blockinganti-rat MASP-2 Fab2 antibodies that were generated as described inExample 24.

Methods:

As shown in FIG. 13, the following proteins, all with N-terminal 6× Histags were expressed in CHO cells using the pED4 vector:

rat MASP-2A, a full length MASP-2 protein, inactivated by altering theserine at the active center to alanine (S613A);

rat MASP-2K, a full-length MASP-2 protein altered to reduceautoactivation (R424K);

CUBI-II, an N-terminal fragment of rat MASP-2 that contains the CUBI,EGF-like and CUBIT domains only; and

CUBI/EGF-like, an N-terminal fragment of rat MASP-2 that contains theCUBI and EGF-like domains only.

These proteins were purified from culture supernatants bynickel-affinity chromatography, as previously described (Chen et al., J.Biol. Chem. 276:25894-02 (2001)).

A C-terminal polypeptide (CCPII-SP), containing CCPII and the serineprotease domain of rat MASP-2, was expressed in E. coli as a thioredoxinfusion protein using pTrxFus (Invitrogen). Protein was purified fromcell lysates using Thiobond affinity resin. The thioredoxin fusionpartner was expressed from empty pTrxFus as a negative control.

All recombinant proteins were dialyzed into TBS buffer and theirconcentrations determined by measuring the OD at 280 nm.

Dot Blot Analysis:

Serial dilutions of the five recombinant MASP-2 polypeptides describedabove and shown in FIG. 13 (and the thioredoxin polypeptide as anegative control for CCPII-serine protease polypeptide) were spottedonto a nitrocellulose membrane. The amount of protein spotted rangedfrom 100 ng to 6.4 pg, in five-fold steps. In later experiments, theamount of protein spotted ranged from 50 ng down to 16 pg, again infive-fold steps. Membranes were blocked with 5% skimmed milk powder inTBS (blocking buffer) then incubated with 1.0 μg/ml anti-MASP-2 Fab2s inblocking buffer (containing 5.0 mM Ca²⁺). Bound Fab2s were detectedusing HRP-conjugated anti-human Fab (AbD/Serotec; diluted 1/10,000) andan ECL detection kit (Amersham). One membrane was incubated withpolyclonal rabbit-anti human MASP-2 Ab (described in Stover et al., JImmunol 163:6848-59 (1999)) as a positive control. In this case, boundAb was detected using HRP-conjugated goat anti-rabbit IgG (Dako; diluted1/2,000).

MASP-2 Binding Assay

ELISA plates were coated with 1.0 μg/well of recombinant MASP-2A orCUBI-II polypeptide in carbonate buffer (pH 9.0) overnight at 4° C.Wells were blocked with 1% BSA in TBS, then serial dilutions of theanti-MASP-2 Fab2s were added in TBS containing 5.0 mM Ca²⁺. The plateswere incubated for one hour at RT. After washing three times withTBS/tween/Ca²⁺, HRP-conjugated anti-human Fab (AbD/Serotec) diluted1/10,000 in TBS/Ca²⁺ was added and the plates incubated for a furtherone hour at RT. Bound antibody was detected using a TMB peroxidasesubstrate kit (Biorad).

Results:

Results of the dot blot analysis demonstrating the reactivity of theFab2s with various MASP-2 polypeptides are provided below in TABLE 7.The numerical values provided in TABLE 7 indicate the amount of spottedprotein required to give approximately half-maximal signal strength. Asshown, all of the polypeptides (with the exception of the thioredoxinfusion partner alone) were recognized by the positive control Ab(polyclonal anti-human MASP-2 sera, raised in rabbits).

TABLE 7 REACTIVITY WITH VARIOUS RECOMBINANT RAT MASP-2 POLYPEPTIDES ONDOT BLOTS Fab2 CUBI/ Antibody EGF- Thiore- # MASP-2A CUBI-II likeCCPII-SP doxin 40 0.16 ng NR NR 0.8 ng NR 41 0.16 ng NR NR 0.8 ng NR 110.16 ng NR NR 0.8 ng NR 49 0.16 ng NR NR >20 ng  NR 52 0.16 ng NR NR 0.8ng NR 57 0.032 ng NR NR NR NR 58 0.4 ng NR NR 2.0 ng NR 60 0.4 ng  0.4ng NR NR NR 63 0.4 ng NR NR 2.0 ng NR 66 0.4 ng NR NR 2.0 ng NR 67 0.4ng NR NR 2.0 ng NR 71 0.4 ng NR NR 2.0 ng NR 81 0.4 ng NR NR 2.0 ng NR86 0.4 ng NR NR  10 ng NR 87 0.4 ng NR NR 2.0 ng NR Positive <0.032 ng0.16 ng 0.16 ng <0.032 ng   NR ControlNR=No reaction. The positive control antibody is polyclonal anti-humanMASP-2 sera, raised in rabbits.

All of the Fab2s reacted with MASP-2A as well as MASP-2K (data notshown). The majority of the Fab2s recognized the CCPII-SP polypeptidebut not the N-terminal fragments. The two exceptions are Fab2 #60 andFab2 #57. Fab2 #60 recognizes MASP-2A and the CUBI-II fragment, but notthe CUBI/EGF-like polypeptide or the CCPII-SP polypeptide, suggesting itbinds to an epitope in CUBII, or spanning the CUBIT and the EGF-likedomain. Fab2 # 57 recognizes MASP-2A but not any of the MASP-2 fragmentstested, perhaps indicating that this Fab2 recognizes an epitope in CCP1.Fab2 #40 and #49 bound only to complete MASP-2A. In the ELISA bindingassay shown in FIG. 14, Fab2 #60 also bound to the CUBI-II polypeptide,albeit with a slightly lower apparent affinity.

These finding demonstrate the identification of unique blocking Fab2s tomultiple regions of the MASP-2 protein

Example 26

This example describes the analysis of MASP-2−/− mice in a Murine RenalIschemia/Reperfusion Model.

Background/Rationale: Ischemia-Reperfusion (I/R) injury in kidney atbody temperature has relevance in a number of clinical conditions,including hypovolaemic shock, renal artery occlusion and cross-clampingprocedures.

Kidney ischemia-reperfusion (I/R) is an important cause of acute renalfailure, associated with a mortality rate of up to 50% (Levy et al.,JAMA 275:1489-94, 1996; Thadhani et al., N. Engl. J Med. 334:1448-60,1996). Post-transplant renal failure is a common and threateningcomplication after renal transplantation (Nicholson et al., Kidney

Int. 58:2585-91, 2000). Effective treatment for renal FR injury iscurrently not available and hemodialysis is the only treatmentavailable. The pathophysiology of renal FR injury is complicated. Recentstudies have shown that the lectin pathway of complement activation mayhave an important role in the pathogenesis of renal I/R injury (deVrieset al., Am. J. Path. 165:1677-88, 2004).

Methods:

A MASP-2(−/−) mouse was generated as described in Example 1 andbackcrossed for at least 10 generations with C57B1/6. Six maleMASP-2(−/−) and six wildtype (+/+) mice weighing between 22-25 g wereadministered an intraperitoneal injection of Hypnovel (6.64 mg/kg; Rocheproducts Ltd. Welwyn Garden City, UK), and subsequently anaesthetized byinhalation of isoflurane (Abbott Laboratories Ltd., Kent, UK).Isoflurane was chosen because it is a mild inhalation anaesthetic withminimal liver toxicity; the concentrations are produced accurately andthe animal recovers rapidly, even after prolonged anaesthesia. Hypnovelwas administered because it produces a condition of neuroleptanalgesiain the animal and means that less isoflurane needs to be administered. Awarm pad was placed beneath the animal in order to maintain a constantbody temperature. Next, a midline abdominal incision was performed andthe body cavity held open using a pair of retractors. Connective tissuewas cleared above and below the renal vein and artery of both right andleft kidneys, and the renal pedicle was clamped via the application ofmicroaneurysm clamps for a period of 55 minutes. This period of ischemiawas based initially on a previous study performed in this laboratory(Zhou et al., J. Clin. Invest. 105:1363-71 (2000)). In addition, astandard ischemic time of 55 minutes was chosen following ischemictitration and it was found that 55 minutes gave consistent injury thatwas also reversible, with low mortality, less than 5%. After occlusion,0.4 ml of warm saline (37° C.) was placed in the abdominal cavity andthen the abdomen was closed for the period of ischemia. Followingremoval of the microaneurysm clamps, the kidneys were observed untilcolor change, an indication of blood re-flow to the kidneys. A further0.4 ml of warm saline was placed in the abdominal cavity and the openingwas sutured, whereupon animals were returned to their cages. Tail bloodsamples were taken at 24 hours after removing the clamps, and at 48hours the mice were sacrificed and an additional blood sample wascollected.

Assessment of Renal Injury: Renal function was assessed at 24 and 48hours after reperfusion in six male MASP-2(−/−) and six WT (+/+) mice.Blood creatinine measurement was determined by mass spectrometry, whichprovides a reproducible index of renal function (sensitivity <1.0μmol/L). FIG. 15 graphically illustrates the blood urea nitrogenclearance for wildtype C57B1/6 controls and MASP-2 (−/−) at 24 hours and48 hours after reperfusion. As shown in FIG. 15, MASP-2(−/−) micedisplayed a significant reduction in the amount of blood urea at 24 and48 hours, in comparison to wildtype control mice, indicating aprotective functional effect from renal damage in the ischemiareperfusion injury model.

Overall, increased blood urea was seen in both the WT (+/+) and MASP-2(−/−) mice at 24 and 48 hours following the surgical procedure andischemic insult. Levels of blood urea in a non-ischemic WT (+/+) surgeryanimal was separately determined to be 5.8 mmol/L. In addition to thedata presented in FIG. 15, one MASP-2 (−/−) animal showed nearlycomplete protection from the ischemic insult, with values of 6.8 and 9.6mmol/L at 24 and 48 hours, respectively. This animal was excluded fromthe group analysis as a potential outlier, wherein no ischemic injurymay have been present. Therefore, the final analysis shown in FIG. 15included 5 MASP-2(−/−) mice and 6 WT (+/+) mice and a statisticallysignificant reduction in blood urea was seen at 24 and 48 hours in theMASP-2 (−/−) mice (Student t-test p<0.05). These findings indicateinhibition of MASP-2 activity would be expected to have a protective ortherapeutic effect from renal damage due to ischemic injury.

Example 27

This example describes the analysis of MASP-2(−/−) mice in a MouseMyocardial Ischemia/Reperfusion Model.

Background/Rationale:

The mannose-binding lectin (MBL) is a circulating molecule thatinitiates complement activation in an immune complex-independentfashion, in response to a wide range of carbohydrate structures. Thesestructures can be components of infectious agents or altered endogenouscarbohydrate moieties particularly within necrotic, oncotic or apoptoticcells. These forms of cell death occur in reperfused myocardium wherethe activation of complement likely extends injury beyond the boundarythat exists at the moment when ischemia is terminated by reperfusion.Although there is compelling evidence that complement activationaggravates myocardial reperfusion, the mechanism of such activation isnot well understood and inhibition of all known pathways is likely tohave intolerable adverse effects. A recent study suggests thatactivation may involve the MBL, rather than classical pathway oralternative amplification loop (as defined in the present invention),since infarction was reduced in MBL(A/C)-, but not C1q-, null mice(Walsh M. C. et al., Jour of Immunol. 175:541-546 (2005)). However,although encouraging, these mice still harbor circulating components,such as Ficolin A, capable of activating complement through the lectinpathway.

This study investigated MASP-2(−/−) mice versus wild type (+/+) controlsto determine if the MASP-2(−/−) would be less sensitive to myocardialischemia and reperfusion injury. MASP-2(−/−) mice were subjected toregional ischemia and infarct size was compared to their wild typelittermates.

Methods: The following protocol was based on a procedure for inducingischemia/reperfusion injury previously described by Marber et al., J.Clin Invest. 95:1446-1456 (1995)).

A MASP-2(−/−) mouse was generated as described in Example 1 andbackcrossed for at least 10 generations with C57B¹/₆. Seven MASP-2 (−/−)mice and seven wildtype (+/+) mice were anesthetized withketamine/medetomidine (100 mg/kg and 0.2 mg/kg respectively) and placedsupine on a thermostatically controlled heating pad to maintain rectaltemperature at 37 ±0.3° C. The mice were intubated under direct visionand ventilated with room air at a respiratory rate of 110/min and atidal volume of 225 μl/min (Ventilator—

Hugo Sachs Elektronic MiniVent Type 845, Germany).

Fur hair was shaved and an anterolateral skin incision made from theleft axilla to the processus xiphoideus. The pectoralis major muscle wasdissected, cut at its sternal margin and moved into the axillary pit.The pectoralis minor muscle was cut at its cranial margin and movedcaudally. The muscle was later used as a muscle flap covering the heartduring coronary artery occlusion. Muscles of the 5th intercostal spaceand the pleura parietalis were penetrated with tweezers at a pointslightly medial to the margin of the left lung, thus avoiding damage ofthe lung or the heart. After penetration of the pleura the tweezers werecarefully directed beyond the pleura towards the sternum withouttouching the heart, and pleura and intercostal muscles were dissectedwith a battery driven cauterizer (Harvard Apparatus, UK). Special carewas exercised in avoiding any bleeding. Using the same technique, thethoracotomy was extended to the mid axillary line. After cutting the 4thrib at its sternal margin the intercostal space was widened until thewhole heart exposed from base to apex. With two small artery forceps thepericardium was opened and a pericardial cradle fashioned to move theheart slightly anterior. The left anterior descending coronary artery(LAD) was exposed and a 8-0 monofilament suture with a round needle wasthen passed under the LAD. The site of ligation of the LAD lies justcaudal of the tip of the left atrium, about ¼ along the line runningfrom the atrioventricular crest to the apex of the left ventricle.

All experiments were carried out in a blinded manner, with theinvestigator being unaware of the genotype of each animal. Aftercompletion of instrumentation and surgical procedures, mice were alloweda 15 min equilibration period. Mice then underwent 30 min of coronaryartery occlusion with 120 min of reperfusion time.

Coronary Artery Occlusion and Reperfusion Model

Coronary artery occlusion was achieved using the hanging weight systemas previously described (Eckle et al., Am J Physiol Heart Circ Physiol291:H2533-H2540, 2006). Both ends of the monofilament ligature werepassed through a 2 mm long piece of a polythene PE-10 tube and attachedto a length of 5-0 suture using cyanoacrylate glue. The suture was thendirected over two horizontally mounted movable metal rods, and masses of1 g each were attached to both ends of the suture. By elevation of therods, the masses were suspended and the suture placed under controlledtension to occlude the LAD with a defined and constant pressure. LADocclusion was verified by paleness of the area at risk, turning color ofthe LAD perfusion zone from bright red to violet, indicating cessationof blood flow. Reperfusion was achieved by lowering the rods until themasses lay on the operating pad and the tension of the ligature wasrelieved. Reperfusion was verified by the same three criteria used toverify occlusion. Mice were excluded from further analysis if all threecriteria were not met at either start of coronary artery occlusion orwithin 15 min of reperfusion, respectively. During coronary arteryocclusion, temperature and humidity of the heart surface were maintainedby covering the heart with the pectoralis minor muscle flap and bysealing the thoracotomy with a 0.9% saline wet gauze.

Measurement of Myocardial Infarct Size:

Infarct size (INF) and area at risk (AAR) were determined by planometry.After i.v. injection of 500 I.U. heparin the LAD was re-occluded and 300μl 5% (w/vol) Evans Blue (Sigma-Aldrich, Poole, UK) was slowly injectedinto the jugular vein to delineate the area at risk (AAR). This causesdye to enter the non-ischemic region of the left ventricle and leavesthe ischemic AAR unstained. After mice had been euthanized by cervicaldislocation, the heart was rapidly removed. The heart was cooled on iceand mounted in a block of 5% agarose and then cut into 8 transverseslices of 800 μm thickness. All slices were incubated at 37° C. for 20min with 3% 2,3,5-triphenyltetrazolium chloride (Sigma Aldrich, Poole,UK) dissolved in 0.1 M Na₂HPO₄/NaH₂PO₄ buffer adjusted to pH 7.4. Sliceswere fixed overnight in 10% formaldehyde. Slices were placed between twocover slips and sides of each slice were digitally imaged using ahigh-resolution optical scanner. The digital images were then analyzedusing SigmaScan software (SPSS, US). The size of infarcted area (pale),left ventricle (LV) area at risk (red) and normally perfused LV zone(blue) were outlined in each section by identification of their colorappearance and color borders. Areas were quantified on both sides ofeach slice and averaged by an investigator. Infarct size was calculatedas a % of risk zone for each animal.

RESULTS: The size of infarcted area (pale), LV area at risk (red) andnormally perfused LV zone (blue) were outlined in each section byidentification of their color appearance and color borders. Areas werequantified on both sides of each slice and averaged by an investigator.Infarct size was calculated as a % of risk zone for each animal. FIG.16A shows the evaluation of seven WT (+/+) mice and seven MASP-2 (−/−)mice for the determination of their infarct size after undergoing thecoronary artery occlusion and reperfusion technique described above. Asshown in FIG. 16A, MASP-2 (−/−) mice displayed a statisticallysignificant reduction (p<0.05) in the infarct size versus the wildtype(+/+) mice, indicating a protective myocardial effect from damage in theischemia reperfusion injury model. FIG. 16B shows the distribution ofthe individual animals tested, indicating a clear protective effect forthe MASP-2 (−/−) mice.

Example 28

This example describes the results of MASP-2−/− in a Murine MacularDegeneration Model.

Background/Rationale: Age-related macular degeneration (AMD) is theleading cause of blindness after age 55 in the industrialized world. AMDoccurs in two major forms: neovascular (wet) AMD and atrophic (dry) AMD.The neovascular (wet) form accounts for 90% of severe visual lossassociated with AMD, even though only ˜20% of individuals with AMDdevelop the wet form. Clinical hallmarks of AMD include multiple drusen,geographic atrophy, and choroidal neovascularization (CNV). In December,2004, the FDA approved Macugen (pegaptanib), a new class of ophthalmicdrugs to specifically target and block the effects of vascularendothelial growth factor (VEGF), for treatment of the wet (neovascular)form of AMD (Ng et al., Nat Rev. Drug Discov 5:123-32 (2006)). AlthoughMacugen represents a promising new therapeutic option for a subgroup ofAMD patients, there remains a pressing need to develop additionaltreatments for this complex disease. Multiple, independent lines ofinvestigation implicate a central role for complement activation in thepathogenesis of AMD. The pathogenesis of choroidal neovascularization(CNV), the most serious form of AMD, may involve activation ofcomplement pathways.

Over twenty-five years ago, Ryan described a laser-induced injury modelof CNV in animals (Ryan, S. J., Tr. Am. Opth. Soc. LXXVII:707-745,1979). The model was initially developed using rhesus monkeys, however,the same technology has since been used to develop similar models of CNVin a variety of research animals, including the mouse (Tobe et al., Am.J. Pathol. 153:1641-46, 1998). In this model, laser photocoagulation isused to break Bruch's membrane, an act which results in the formation ofCNV-like membranes. The laser-induced model captures many of theimportant features of the human condition (for a recent review, seeAmbati et al., Survey Ophthalmology 48:257-293, 2003). The laser-inducedmouse model is now well established, and is used as an experimentalbasis in a large, and ever increasing, number of research projects. Itis generally accepted that the laser-induced model shares enoughbiological similarity with CNV in humans that preclinical studies ofpathogenesis and drug inhibition using this model are relevant to CNV inhumans.

Methods:

A MASP-2−/− mouse was generated as described in Example 1 andbackcrossed for 10 generations with C57B¹/₆. The current study comparedthe results when MASP-2 (−/−) and MASP-2 (+/+) male mice were evaluatedin the course of laser-induced CNV, an accelerated model of neovascularAMD focusing on the volume of laser-induced CNV by scanning laserconfocal microscopy as a measure of tissue injury and determination oflevels of VEGF, a potent angiogenic factor implicated in CNV, in theretinal pigment epithelium (RPE)/choroids by ELISA after laser injury.

Induction of choroidal neovascularization (CNV): Laser photocoagulation(532 nm, 200 mW, 100 ms, 75 μm; Oculight GL, Iridex, Mountain View,Calif.) was performed on both eyes of each animal on day zero by asingle individual masked to drug group assignment. Laser spots wereapplied in a standardized fashion around the optic nerve, using a slitlamp delivery system and a coverslip as a contact lens. The morphologicend point of the laser injury was the appearance of a cavitation bubble,a sign thought to correlate with the disruption of Bruch's membrane. Thedetailed methods and endpoints that were evaluated are as follows.

Fluorescein Angiography: Fluorescein angiography was performed with acamera and imaging system (TRC 50 1A camera; ImageNet 2.01 system;Topcon, Paramus , N.J.) at 1 week after laser photocoagulation. Thephotographs were captured with a 20-D lens in contact with the funduscamera lens after intraperitoneal injection of 0.1 ml of 2.5%fluorescein sodium. A retina expert not involved in the laserphotocoagulation or angiography evaluated the fluorescein angiograms ata single sitting in masked fashion.

Volume of choroidal neovascularization (CNV): One week after laserinjury, eyes were enucleated and fixed with 4% paraformaldehyde for 30min at 4° C. Eye cups were obtained by removing anterior segments andwere washed three times in PBS, followed by dehydration and rehydrationthrough a methanol series. After blocking twice with buffer (PBScontaining 1% bovine serumalbumin and 0.5% Triton X-100) for 30 minutesat room temperature, eye cups were incubated overnight at 4° C. with0.5% FITC-isolectin B4 (Vector laboratories, Burlingame, Calif.),diluted with PBS containing 0.2% BSA and 0.1% Triton X-100, which bindsterminal β-D-galactose residues on the surface of endothelial cells andselectively labels the murine vasculature. After two washings with PBScontaining 0.1% Triton X-100, the neurosensory retina was gentlydetached and severed from the optic nerve. Four relaxing radialincisions were made, and the remaining RPE—choroid-sclera complex wasflatmounted in antifade medium (Immu-Mount Vectashield Mounting Medium;Vector Laboratories) and cover-slipped.

Flatmounts were examined with a scanning laser confocal microscope (TCSSP; Leica, Heidelberg, Germany). Vessels were visualized by excitingwith blue argon wavelength (488 nm) and capturing emission between 515and 545 nm. A 40× oil-immersion objective was used for all imagingstudies. Horizontal optical sections (1 μm step) were obtained from thesurface of the RPE-choroid-sclera complex. The deepest focal plane inwhich the surrounding choroidal vascular network connecting to thelesion could be identified was judged to be the floor of the lesion. Anyvessel in the laser-targeted area and superficial to this referenceplane was judged as CNV. Images of each section were digitally stored.The area of CNV-related fluorescence was measured by computerized imageanalysis with the microscope software (TCS SP; Leica). The summation ofwhole fluorescent area in each horizontal section was used as an indexfor the volume of CNV. Imaging was performed by an operator masked totreatment group assignment.

Because the probability of each laser lesion developing CNV isinfluenced by the group to which it belongs (mouse, eye, and laserspot), the mean lesion volumes were compared using a linear mixed modelwith a split plot repeated-measures design. The whole plot factor wasthe genetic group to which the animal belongs, whereas the split plotfactor was the eye. Statistical significance was determined at the 0.05level. Post hoc comparisons of means were constructed with a Bonferroniadjustment for multiple comparisons.

VEGF ELISA. At three days after injury by 12 laser spots, theRPE-choroid complex was sonicated in lysis buffer (20 mM imidazole HCl,10 mM KCl, 1 mM MgCL₂, 10 mM EGTA, 1% Triton X-100, 10 mM NaF, 1 mM Namolybdate, and 1 mM EDTA with protease inhibitor) on ice for 15 min.VEGF protein levels in the supernatant were determined by an ELISA kit(R&D Systems, Minneapolis, Minn.) that recognizes all splice variants,at 450 to 570 nm (Emax; Molecular Devices, Sunnyvale, Calif.), andnormalized to total protein. Duplicate measurements were performed in amasked fashion by an operator not involved in photocoagulation, imaging,or angiography. VEGF numbers were represented as the mean+/−SEM of atleast three independent experiments and compared using the Mann-WhitneyU test. The null hypothesis was rejected at P<0.05.

Results:

Assessment of VEGF Levels:

FIG. 17A graphically illustrates the VEGF protein levels in RPE-choroidcomplex isolated from C57B16 wildtype and MASP-2(−/−) mice at day zero.As shown in FIG. 17A, the assessment of VEGF levels indicate a decreasein baseline levels for VEGF in the MASP-2 (−/−) mice versus the C57b1wildtype control mice. FIG. 17B graphically illustrates VEGF proteinlevels measured at day three following laser induced injury. As shown inFIG. 17B VEGF levels were significantly increased in the wildtype (+/+)mice three days following laser induced injury, consistent withpublished studies (Nozaki et al., Proc. Natl. Acad. Sci. USA 103:2328-33(2006)). However, surprisingly very low levels of VEGF were seen in theMASP-2 (−/−) mice.

Assessment of Choroidal Neovascularization (CNV):

In addition to the reduction in VEGF levels following laser inducedmacular degeneration, CNV area was determined before and after laserinjury. FIG. 18 graphically illustrates the CNV volume measured in C57b1wildtype mice and MASP-2(−/−) mice at day seven following laser inducedinjury. As shown in FIG. 18, the MASP-2 (−/−) mice displayed about a 30%reduction in the CNV area following laser induced damage at day seven incomparison to the wildtype control mice.

These findings indicate a reduction in VEGF and CNV as seen in the MASP(−/−) mice versus the wildtype (+/+) control and that blockade of MASP-2with an inhibitor would have a preventive or therapeutic effect in thetreatment of macular degeneration.

Example 29

This example describes the results of MASP-2(−/−) in a Murine MonoclonalAntibody Induced Rheumatoid Arthritis Model

Background/Rationale: The most commonly used animal model for rheumatoidarthritis (RA) is the collagen-induced arthritis (CIA) (for recentreview, see Linton and Morgan, Mol. Immunol. 36:905-14, 1999). Collagentype II (CII) is one of the major constituents of the articular matrixproteins and immunization with native CII in adjuvant induces autoimmunepolyarthritis by a cross-reactive autoimmune response to CII in jointcartilage. As in RA, susceptibility to CIA is linked to the expressionof certain class II MHC alleles. Some strains of mice, including theC57B1/6 strain, are resistant to classic CIA because they lack anappropriate MHC haplotype and therefore do not generate high anti-CIIantibody titers. However, it has been found that consistent arthritiscan be induced in all strains of mice by the i. v. or i.p.administration into mice of a cocktail of four specific monoclonalantibodies against type II collagen. These arthridogenic monoclonalantibodies are commercially available (Chondrex, Inc., Redmond, WA).This passive transfer model of CIA has been used successfully in anumber of recent published reports using the C57B1/6 mouse strain(Kagari et al., J. Immunol. 169:1459-66, 2002; Kato et al., J.Rheumatol. 30:247-55, 2003; Banda et al, J. Immunol. 177:1904-12, 2006).The following study compared the sensitivity of wild type (+/+) (WT) andMASP-2 (−/−) mice, both sharing the C57B1/6 genetic background, todevelopment of arthritis using the passive transfer model of CIA.

Methods:

Animals: A MASP-2(−/−) mouse was generated as described in Example 1 andbackcrossed for 10 generations with C57B¹/₆. Fourteen male and femaleC57BL/6 wild type mice that were seven to eight weeks old at the time ofantibody injection and ten male and female MASP-2(−/−) and wildtype(+/+) C57B¹/₆ mice that were seven to eight weeks old at time ofantibody injection were used in this study. Twenty mice were injectedwith a monoclonal antibody cocktail to obtain 20 solid responders (twogroups of ten). The animals (ten/group) were housed with fiveanimals/cage, and were acclimated for five to seven days prior toinitiating the study.

Mice were injected intravenously with a monoclonal antibody cocktail(Chondrex, Redmond Wash.) (5 mg) on day 0 and day 1. The test agent wasa monoclonal antibody +LPS from Chondrex. On day 2, mice were dosed ipwith LPS. Mice were weighed on days 0, 2, 4, 6, 8, 10, 12 and prior totermination on day 14. On day 14 the mice were anesthetized withisoflurane and bled terminally for serum. After blood collection, themice were euthanized, with removal of both fore and hind limbs withknees, which were placed into formalin for future processing.

Treatment Groups:

Group 1 (control): 4 mice of strain C57/BL/6 WT (+/+);

Group 2 (test): 10 mice of strain C57/BL/6 WT (+/+) (received mAbcocktail plus LPS); and

Group 3 (test): 10 mice of strain C57/BL/MASP-2K0/6Ai (−/−) (receivedmAb cocktail plus LPS)

Clinical arthritic scores were assessed daily using the followingscoring system: 0=normal; 1=1 hind or fore paw joint affected; 2=2 hindor fore paw joints affected; 3=3 hind or fore paw joints affected;4=moderate (erythema and moderate swelling, or 4 digit joints affected);5=severe (diffuse erythema and severe swelling entire paw, unable toflex digits)

Results:

FIG. 19 shows the group data plotted for the mean daily clinicalarthritis score for up to two weeks. No clinical arthritis score wasseen in the control group that did not receive the CoL2 MoAb treatment.The MASP (−/−) mice had a lower clinical arthritis score from day 9 today 14. The overall clinical arthritis score with area under the curveanalysis (AUC) indicated a 21% reduction in the MASP-2 (−/−) groupversus the WT (+/+) mice. However, C57B16 mouse background as discussedpreviously did not provide for a robust overall arthritis clinicalscore. Due to the small incidence rate and group size, while positivelytrending, the data provided only trends (p =0.1) and was notstatistically significant at the p <0.05 level. Additional animals inthe treatment groups would be necessary to show statisticalsignificance. Due to the reduced incidence of arthritis, the affectedpaw scores were evaluated for severity. No single incidence of aclinical arthritis score of greater than 3 was seen in any of the MASP-2(−/−) mice, which was seen in 30% of the WT (+/+) mice, furthersuggesting that (1) the severity of the arthritis may be related tocomplement pathway activation and (2) that blockade of MASP-2 may have abeneficial effect in arthritis.

Example 30

This Example demonstrates that Small Mannose-Binding Lectin-AssociatedProtein (Map19 or sMAP) is an inhibitor of MASP-2 dependent complementactivation.

Background/Rationale: Abstract:

Mannose-binding lectin (MBL) and ficolins are pattern recognitionproteins acting in innate immunity and trigger the activation of thelectin complement pathway through MBL-associated serine proteases(MASPs). Upon activation of the lectin pathway, MASP-2 cleaves C4 andC2. Small MBL-associated protein (sMAP), a truncated form of MASP-2, isalso associated with MBL/ficolin—MASP complexes. To clarify the role ofsMAP, we have generated sMAP-deficient (sMAP−/−) mice by targeteddisruption of the sMAP-specific exon. Because of the gene disruption,the expression level of MASP-2 was also decreased in sMAP−/− mice. Whenrecombinant sMAP (rsMAP) and recombinant MASP-2 (rMASP-2) reconstitutedthe MBL-MASP-sMAP complex in deficient serum, the binding of theserecombinants to MBL was competitive, and the C4 cleavage activity of theMBL-MASP-sMAP complex was restored by the addition of rMASP-2, whereasthe addition of rsMAP attenuated the activity. Therefore, MASP-2 isessential for the activation of C4 and sMAP plays a regulatory role inthe activation of the lectin pathway.

Introduction:

The complement system mediates a chain reaction of proteolysis andassembly of protein complexes, playing a major role in biodefense as apart of both the innate and adaptive immune systems. The mammaliancomplement system consists of three activation pathways, the classicalpathway, alternative pathway, and lectin pathway (Fujita, Nat. Rev.Immunol. 2: 346-353 (2002); Walport, N Engl J Med 344: 1058-1066(2001)). The lectin pathway provides the primary line of defense againstinvading pathogens. The pathogen recognition components of this pathway,mannose-binding lectin (MBL) and ficolins, bind to arrays ofcarbohydrates on the surfaces of bacteria, viruses, and parasites andactivate MBL-associated serum proteases (MASPs) to trigger a downstreamreaction cascade. The importance of the lectin pathway for innate immunedefense is underlined by a number of clinical studies linking adeficiency of MBL with increased susceptibility to a variety ofinfectious diseases, particularly in early childhood before the adaptiveimmune system is established (Jack et al., Immunol Rev 180:86-99 (2001);Neth et al. Infect Immun 68: 688-693 (2000); Summerfield et al., Lancet345:886-889 (1995); Super et al., Lancet 2: 1236-1239 (1989)). However,the lectin pathway also contributes to the undesired activation ofcomplement, which is involved in inflammation and tissue damage in anumber of pathological conditions, including ischemia/perfusion injuryin the heart and kidneys (de Vries et al., Am J Pathol 165:1677-1688(2004); Fiane et al., Circulation 108: 849-856 (2003); Jordan et al.,Circulation 104: 1413-1418 (2001); Walsh et al., J Immunol 175:541-546(2005)).

As mentioned above, the lectin pathway involves carbohydrate recognitionby MBL and ficolins (Fujita et al, Immunol Rev 198: 185-202 (2004);Holmskov et al, Annu Rev Immunol 21: 547-578 (2003); Matsushita andFujita, Immunobiology 205: 490-497 (2002) and these lectins formcomplexes with MASP-1 (Matsushita and Fujita, J Exp Med 176: 1497-1502(1992); Sato et al, Int Immunol 6: 665-669 (1994); Takada et al, BiochemBiophys Res Commun 196: 1003-1009 (1993), MASP-2 (Thiel et al, Nature386:506-510 (1997), MASP-3 (Dahl et al, Immunity 15: 127-135 (2001), anda truncated protein of MASP-2 (small MBL-associated protein; sMAP orMAp19) (Stover et al, J Immunol 162: 3481-3490 (1999); Takahashi et al,Int Immunol 11: 8590863 (1999). The MASP family members consist of sixdomains; two C1r/C1s/Uegf/bone morphogenetic protein (CUB) domains, anepidermal growth factor (EGF)-like domain, two complement controlprotein (CCP) or short consensus repeats (SCR) domains, and a serineprotease domain (Matsushita et al, Curr Opin Immunol 10: 29-35 (1998).MASP-2 and sMAP are generated by alternative splicing from a singlestructural gene, and sMAP consists of the first CUB (CUB1) domain, theEGF-like domain and an extra 4 amino acids at the C-terminal end encodedby a sMAP-specific exon. MASP-1 and MASP-3 are also generated from asingle gene by alternative splicing (Schwaeble et al, Immunobiology 205:455-466 (2002). When MBL and ficolins bind to carbohydrates on thesurface of microbes, the proenzyme form of MASP is cleaved between thesecond CCP and the protease domain, resulting in the active formconsisting of two polypeptides, called heavy (H)- and light (L)-chains,and thus acquiring proteolytic activities against complement components.Accumulated evidence shows that MASP-2 cleaves C4 and C2 (Matsushita etal, J Immunol 165: 2637-2642 (2000) which leads to the formation of theC3 convertase (C4bC2a). We proposed that MASP-1 cleaves C3 directly andsubsequently activates the amplification loop (Matsushita and Fujita,Immunobiology 194: 443-448 (1995), but this function is controversial(Ambrus et al, J. Immunol 170: 1374-1382 (2003). Although MASP-3 alsocontains a serine protease domain in the L-chain and exhibits itsproteolytic activity against a synthetic substrate (Zundel et al, JImmunol 172: 4342-4350 (2004), its physiological substrates have notbeen identified. The function of sMAP lacking the serine protease domainremains unknown.

In the present study, to clarify the role of sMAP in activation of thelectin complement pathway, we have disrupted the sMAP-specific exon thatencodes 4 amino acid residues (EQSL) at the C-terminal end of sMAP, andgenerated sMAP−/− mice. We report here for the first time the ability ofsMAP to down-regulate activation of the lectin pathway.

Materials and Methods Mice

A targeting vector was constructed containing exon 1-4 and part of exon6 of the 129/Sv mouse MASP-2 gene and a neomycin resistance genecassette instead of exon 5 (FIG. 20A). A DT-A gene was inserted into the3′ end of the vector and three lox p sites were inserted to performconditional targeting to remove the neomycin cassette and promoterregion in the future. The targeting vector was electroporated into129/Sv ES cells. The targeted ES clones were microinjected into C57BL/6Jblastocysts which were implanted into uteri of foster ICR mothers. Malechimeric mice were mated with female C57BL/6J mice to produceheterozygous (+/-) mice. Heterozygous (+/-) mice were screened bySouthern blot analysis of tail DNA digested with BamH I using the probeindicated in FIG. 20A. Southern blot analysis showed 6.5-kbp and 11-kbpbands in DNA from heterozygous (+/−) mice (FIG. 20B). Heterozygous (+/−)mice were backcrossed with C57BL/6J mice. To obtain homozygous (−/−)mice, heterozygous (+/-) mice were intercrossed. Homozygous (−/−) mice(C57BL/6J background) were identified by PCR-based genotyping of tailDNA. PCR analysis was performed using a mixture of exon 4-specific andneo gene-specific sense primers and an exon 6-specific antisense primer.DNA from homozygous (−/−) mice yielded a single 1.8-kbp band (FIG. 20C).In all experiments, 8 to 12 week old mice were used according to theguidelines for animal experimentation of Fukushima Medical University.

Northern Blot Analysis

Poly(A)+RNA (1 μg) from wild-type (+/+) and homozygous (−/−) mouselivers was separated by electrophoresis, transferred to a nylonmembrane, and hybridized with a 32P-labeled cDNA probe specific forsMAP, MASP-2 H-chain, MASP-2 L-chain, or the neo gene. The same membranewas stripped and rehybridized with a probe specific forglyceraldehyde-3-phosphate dehydrogenase (GAPDH).

Quantitative RT-PCR

Real-time PCR was performed with the LightCycler System (RocheDiagnostics). cDNAs synthesized from 60 ng of poly(A)+RNA from wild-type(+/+) and homozygous (−/−) mouse livers were used as templates forreal-time PCR and cDNA fragments of MASP-2 H- and L-chains and sMAP wereamplified and monitored.

Immunoblotting

The sample was electrophoresed on 10 or 12% SDS-polyacrylamide gelsunder reducing conditions and proteins were transferred topolyvinylidene difluoride (PVDF) membranes. Proteins on the membraneswere detected with anti-MASP-1 antiserum raised against the L-chain ofMASP-1 or with anti-MASP-2/sMAP antiserum raised against the peptidefrom the H-chain of MASP-2.

Detection of MASPs and sMAP in the MBL-MASP-sMAP Complex

Mouse serum (20 μl) was added to 480 μl of TBS-Ca2+ buffer (20 mMTris-HCl, pH 7.4, 0.15 M NaCl, and 5 mM CaCl2) containing 0.1% (w/v) BSA(TBS-Ca2+/BSA) and incubated with 40 μl of 50% mannan-agarose gel slurry(Sigma-Aldrich, St. Louis, Mo.) in TBS-Ca2+/BSA buffer at 4° C. for 30min. After incubation each gel was washed with TBS-Ca2+ buffer and thesampling buffer for SDS-PAGE was added to the gel. The gel was boiledand the supernatant was subjected to SDS-PAGE, followed byimmunoblotting to detect MASP-1, MASP-2, and sMAP in the MBL complex.

C4 Deposition Assay

Mouse serum was diluted with TBS-Ca2+/BSA buffer up to 100 μl. Thediluted sample was added to mannan-coated microtiter wells and incubatedat room temperature for 30 min. The wells were washed with the chilledwashing buffer (TBS-Ca2+ buffer containing 0.05% (v/v) Tween 20). Afterthe washing, human C4 was added to each well and incubated on ice for 30min. The wells were washed with the chilled washing buffer andHRP-conjugated anti-human C4 polyclonal antibody (Biogenesis, Poole,England) was added to each well. Following incubation at 37° C. for 30min, the wells were washed with the washing buffer and3,3′,5,5′-tetramethylbenzidine (TMB) solution was added to each well.After developing, 1 M H₃PO₄ was added and the absorbance was measured at450 nm.

C3 Deposition Assay

Mouse serum was diluted with BBS buffer (4 mM barbital, 145 mM NaCl, 2mM CaCl2, and 1 mM MgC12, pH 7.4) containing 0.1% (w/v) HSA up to 100μl. The diluted sample was added to mannan-coated microtiter wells andincubated at 37° C. for 1 h. The wells were washed with the washingbuffer. After the washing, HRP-conjugated anti-human C3c polyclonalantibody (Dako, Glostrup, Denmark) was added to each well. Followingincubation at room temperature for 1 h, the wells were washed with thewashing buffer and TMB solution was added to each well. The color wasmeasured as described above.

Recombinants

Recombinant mouse sMAP (rsMAP), rMASP-2, and the inactive mouse MASP-2mutant (MASP-2i) whose active-site serine residue in the serine proteasedomain was substituted for the alanine residue were prepared asdescribed previously (Iwaki and Fujita, 2005).

Reconstitution of the MBL-MASP-sMAP Complex

Homozygous (−/−) mouse serum (20 μl) and various amounts of MASP-2iand/or rsMAP were incubated in a total volume of 40 μl in TBS-Ca2+buffer on ice overnight. The mixture was incubated with mannan-agarosegel slurry, and MASP-2i and rsMAP in the MBL-MASP complex bound to thegel were detected as described in “Detection of MASPs and sMAP in theMBL-MASP-sMAP complex”.

Reconstitution of the C4 Deposition Activity

Homozygous (−/−) mouse serum (0.5 μl) and various amounts of rMASP-2and/or rsMAP were incubated in a total volume of 20 μl in TBS-Ca2+on iceovernight. The mixture was diluted with 80 μl of TBS-Ca2+/BSA buffer andadded to mannan-coated wells. All subsequent procedures were performedas described in “C4 deposition assay”.

Results

FIG. 20: Targeted disruption of the sMAP gene. (A) Partial restrictionmaps of the MASP-2/sMAP gene, the targeting vector, and the targetedallele. The sMAP-specific exon (exon 5) was replaced with a neo genecassette. (B) Southern blot analysis of genomic DNA from offspringderived from mating male chimeric mice with female C57BL/6J mice. TailDNA was digested with BamH I and hybridized with the probe depicted in(A). A 11-kbp band was derived from the wild-type allele, and a 6.5-kbpband from the targeted allele. (C) PCR genotyping analysis. Tail DNA wasanalyzed using a mixture of exon 4-specific and neo gene-specific senseprimers and an exon 6-specific antisense primer. A 2.5-kbp band wasobtained from wild-type allele, a 1.8-kb band from the targeted allele.

FIG. 21: The expression of sMAP and MASP-2 mRNAs in homozygous (−/−)mice. (A) Northern blot analysis. Poly(A)+RNAs from wild-type (+/+) andhomozygous (−/−) mouse livers was electrophoresed, transferred to anylon membrane, and hybridized with a 32P-labeled probe specific forsMAP, MASP-2 H-chain, MASP-2 L-chain, or the neo gene. A specific bandfor neo (2.2 kb) was observed in homozygous (−/−) mice. (B) QuantitativeRT-PCR. MASP-2 H- and L-chains and sMAP cDNA fragments were amplified byreal-time PCR in a LightCycler instrument (Roche Diagnostics). cDNAssynthesized from poly(A)+RNAs from wild-type (+/+) and homozygous (−/−)mouse livers were used as templates. The data shown are the means of twoexperiments.

FIG. 22: Deficiency of MASP-2 in homozygous (−/−) mouse serum. (A)Immunoblotting of MASP-2 and sMAP in mouse serum. Wild-type (+/+) orhomozygous (−/−) mouse serum (2 μl) was subjected to immunoblotting anddetected with anti-MASP-2/sMAP antiserum. (B) Detection of MASPs andsMAP in the MBL-MASP-sMAP complex. Mouse serum was incubated withmannan-agarose gel and sMAP, MASP-1, and MASP-2 in the MBL complex boundto the gel were detected as described in Materials and Methods.

FIG. 23: Decreased cleavage of C4 and C3 in homozygous (−/−) mouseserum.

(A) Deposition of C4 on mannan-coated wells. Mouse serum was diluted2-fold and incubated in mannan-coated wells at room temperature for 30min. After the washing of the wells, human C4 was added to each well andincubated on ice for 30 min. The amount of human C4 deposited on thewells was measured using HRP-conjugated anti-human C4 polyclonalantibody. (B) Deposition of C3 on mannan-coated wells. Diluted mouseserum was added to mannan-coated wells and incubated at 37° C. for 1 h.The deposition of endogenous C3 on the wells was detected withHRP-conjugated anti-human C3c polyclonal antibody.

FIG. 24: Competitive binding of sMAP and MASP-2 to MBL. (A)Reconstitution of the MBL-MASP-sMAP complex in homozygous (−/−) mouseserum.

MASP-2i and/or rsMAP (4 μg) were incubated with homozygous (−/−) mouseserum (20 μl). The mixture was further incubated with mannan-agarosegel, and rsMAP and MASP-2i in the fraction bound to the gel weredetected by immunoblotting. (B) Various amounts of MASP-2i (0-5 μg) anda constant amount of rsMAP (5 μg) were incubated with homozygous (−/−)mouse serum (20 μl) and further incubated with mannan-agarose gel. (C) Aconstant amount of MASP-2i (0.5 μg) and various amounts of rsMAP (0-20μg) were incubated with homozygous (−/−) mouse serum (20 μl). (D)Various amounts of rsMAP (0-20 μg) was incubated with wild-type (+/+)mouse serum (20 μl).

FIG. 25: Restoration of the C4 deposition activity by addition ofrMASP-2. Various amounts of rsMAP (0-5 μg) (A) or rMASP-2 (0-1.5 μg) (B)were incubated with 0.5 μl of homozygous (−/−) mouse serum in a totalvolume of 20 μl in TBS-Ca2+ buffer on ice overnight. Then the mixturewas diluted with 80 μl of TBS-Ca2+/BSA buffer and added to mannan-coatedwells and the amount of C4 deposited on the wells was measured.

FIG. 26: Reduction of the C4 deposition activity by addition of sMAP.(A) rMASP-2 (1 μg) and various amounts of rsMAP (0-0.5 μg) wereincubated with 0.5 μl of homozygous (−/−) mouse serum. The mixture wasadded to mannan-coated wells and the amount of C4 deposited on the wellswas measured. (B) rsMAP (0-0.7 μg) was incubated with wild-type serum(0.5 μl) and the amount of C4 deposited on mannan-coated wells wasmeasured.

Results:

The expression of sMAP and MASP-2 in homozygous (−/−) mice

To clarify the role of sMAP in vivo, we established a gene targetedmouse which lacks sMAP. A targeting vector was constructed to replacethe specific exon for sMAP (exon 5) with a neomycin resistance genecassette (FIG. 20A). Positive ES clones were injected into C57BL/6blastocysts, and the founder chimeras bred with C57BL/6J females.Southern blot analysis of tail DNA from agouti-color pups showed agerminal transmission of the targeted allele (FIG. 20B). Heterozygous(+/−) mice were screened by Southern blot analysis of tail DNA digestedwith BamH I using the probe indicated in FIG. 20A. Southern blotanalysis showed 6.5-kbp and 11-kbp bands in DNA from heterozygous (+/−)mice (FIG. 20B). Heterozygous (+/−) mice were backcrossed with C57BL/6Jmice. To obtain homozygous (−/−) mice, heterozygous (+/−) mice wereintercrossed. Homozygous (−/−) mice (C57BL/6J background) wereidentified by PCR based genotyping of tail DNA, yielding a single1.8-kbp band (FIG. 20C).

Homozygous (−/−) mice developed normally and showed no significantdifference in body weight from wild-type (+/+) mice. There were nomorphological differences between them either. In a Northern blotanalysis, the probe specific for sMAP detected a single 0.9-kb band inwild-type (+/+) mice, whereas no specific bands were detected inhomozygous (−/−) mice (FIG. 21A). When the probe specific for MASP-2 H-or L-chain was used, several specific bands were detected in wild-type(+/+) mice as reported previously (Stover et al, 1999) and theH-chain-specific probe also detected the sMAP specific-band. However, inhomozygous (−/−) mice the corresponding bands were very weak and severalextra bands were detected. We also performed a quantitative RT-PCRanalysis to check the expression levels of sMAP and MASP-2 mRNAs. Inhomozygous (−/−) mice, the expression of sMAP mRNA was completelyabolished and that of MASP-2 was also decreased markedly: it wasquantitated as about 2% of that of wild-type (+/+) mice in both H- andL-chains by real-time PCR (FIG. 21B). Furthermore, we examined theexpression of MASP-2 at the protein level. Both sMAP and MASP-2 wereundetectable in homozygous (−/−) mouse serum by immunoblotting (FIG.22A). After the incubation of homozygous (−/−) mouse serum withmannan-agarose gel, both sMAP and MASP-2 were not detectable in thefraction bound to the gels, although MASP-1 was detected in the complex(FIG. 22B).

Cleaving Activities of C4 and C3 Through the Lectin Pathway inHomozygous (−/−) Mouse Serum

When homozygous (−/−) mouse serum was incubated in mannan-coated wells,the amount of human C4 deposited on the wells was about 20% of that innormal serum at dilutions ranging from 1/400 to 1/50 (FIG. 23A). We alsoexamined the C3 deposition activity of the lectin pathway in homozygous(−/−) mouse serum. The mouse serum was added to mannan-coated wells andthe amount of endogenous C3 deposited on the wells was measured. Theamount was decreased in the deficient serum and was 21% of that innormal serum at a dilution of 1/10 (FIG. 23B).

Reconstitution of the MBL-MASP-sMAP Complex in Homozygous (−/−) MouseSerum

When recombinant mouse sMAP (rsMAP) or the inactive mouse MASP-2 mutant(MASP-2i) was added to homozygous (−/−) mouse serum, both recombinantswere able to bind to MBL (FIG. 24A, lanes 3 and 4). When rsMAP andMASP-2i were simultaneously incubated with the serum (FIG. 24A, lane 5),both recombinants were detected in the MBL-MASP-sMAP complex. Howeverthe amount of sMAP bound to the complex was less than that when onlyrsMAP was incubated with the serum. Then we further investigated thecompetitive binding of sMAP and MASP-2 to MBL. A constant amount ofrsMAP and various amounts of MASP-2i were added to the deficient serum.The binding of rsMAP decreased in a dose-dependent manner withincreasing amounts of MASP-2i (FIG. 24B). Inversely, the amount ofMASP-2i bound to MBL decreased by the addition of rsMAP (FIG. 24C). WhenrsMAP was added to wild-type serum, the binding both of endogenous sMAPand of MASP-2 to MBL decreased in a dose-dependent manner (FIG. 24D).

Reconstitution of C4 Deposition Activity in Homozygous (−/−) Mouse Serum

We performed a reconstitution experiment of the deposition of C4 onmannan-coated wells using recombinants. When rsMAP was added to thedeficient serum, the amount of C4 deposited actually decreased to basallevels in a dose-dependent manner (FIG. 25A). When rMASP-2 was added tothe serum, the amount of C4 was restored by up to 46% of that ofwild-type serum in a dose-dependent manner and reached a plateau (FIG.25B). Next, we investigated the effect of sMAP on the C4 deposition.When a constant amount of rMASP-2 and various amounts of rsMAP wereadded to the deficient serum, the amount of C4 deposited decreased withthe addition of rsMAP in a dose-dependent manner (FIG. 26A) and theaddition of rsMAP to wild-type serum also decreased the amount of C4deposited (FIG. 26B), suggesting that sMAP plays a regulatory role inthe activation of the lectin pathway.

Discussion

We have generated sMAP−/− mice through targeted disruption of thesMAP-specific exon. The expression level of MASP-2 was also extremelydecreased at both the mRNA and protein levels in these mice (FIGS. 21and 22). A Northern blot analysis with a MASP-2 probe showed only extrabands in poly(A)+RNA from sMAP−/− mice, suggesting that the normalsplicing of the MASP-2 gene was altered by the targeting of the sMAPgene and therefore, the expression level of MASP-2 was markedlydecreased. As a result, the cleavage of C4 by the MBL-MASP complex inthe deficient serum was decreased by about 80% compared to that in thenormal serum (FIG. 23A). In the reconstitution experiments, the C4cleavage activity was restored by addition of rMASP-2 but not rsMAP(FIG. 25). The reduction in the deposition of C4 observed in thedeficient serum should be caused by the deficiency of MASP-2 in theMBL-MASP complex (FIG. 22B). Therefore, it is clear that MASP-2 isessential for the activation of C4 by the MBL-MASP complex. However,addition of rMASP-2 did not completely restore the cleavage activity andthe deposition of C4 reached a plateau. As reported previously (Cseh etal, J Immunol 169: 5735-5743 (2002); Iwaki and Fujita, J Endotoxin Res11: 47-50 (2005), most rMASP-2 was converted to the active form byautoactivation during the purification procedures and some lost itsprotease activity. Since the active or inactive state of MASP-2 has nosignificant influence on its association with MBL (Zundel et al, JImmunol 172: 4342-4350 (2004), it is possible that rMASP-2 which haslost its protease activity binds to MBL and competitively prevents theassociation of the active form, thereby resulting in an incompleterestoration of C4 deposition. The C3 cleavage activity of the lectinpathway was also attenuated in the deficient serum (FIG. 23B). Thedecline in the amount of C3 deposited is probably due to the very lowlevel of activity of the C3 convertase, which consists of C4b and C2afragments generated by MASP-2.

MASP and sMAP each associated as homodimers and formed complexes withMBL or L-ficolin through their N-terminal CUB and EGF-like domains (Chenand Wallis, J Biol Chem 276: 25894-25902 (2001); Cseh et al, J Immunol169: 5735-5743 (2002); Thielens et al, J Immunol 166: 5068-5077 (2001);Zundel et al, J Immunol 172: 4342-4350 (2004)). The crystal structuresof sMAP and the CUB1-EGF-CUB2 segment of MASP-2 reveal their homodimericstructure (Feinberg et al, EMBO J 22: 2348-2359 (2003); Gregory et al, JBiol Chem 278: 32157-32164 (2003)). The collagen-like domain of MBL isinvolved in associating with MASPs (Wallis and Cheng, J Immunol 163:4953-4959 (1999); Wallis and Drickamer, J Biol Chem 279: 14065-14073(1999) and some mutations introduced into the domain have decreased thebinding of MBL to the CUB1-EGF-CUB2 segments of MASP-1 and MASP-2(Wallis and Dodd, J Biol Chem 275: 30962-30969 (2000)). The bindingsites for MASP-2 and for MASP-1/3 overlap but are not identical (Walliset al, J Biol Chem 279: 14065-13073 (2004)). Although the sMAP-bindingsite of MBL has not been identified yet, the binding sites for sMAP andMASP-2 are probably identical, because the CUB1-EGF region is the samein sMAP and MASP-2. Thus, it is reasonable that sMAP and MASP-2 competewith each other to bind MBL in the reconstitution of the MBL-MASP-sMAPcomplex (FIG. 24). The affinity of sMAP for MBL is lower than that ofMASP-2 (Cseh et al, J Immunol 169:5735-5743 (2002); Thielens et al, JImmunol 166: 5068-5077 (2001)). The concentration of sMAP in mouse serumhas not been determined. As shown in FIG. 22A, however, the amount ofsMAP in the wild-type serum is much greater than that of MASP-2.Therefore sMAP is able to occupy the MASP-2/sMAP binding site andprevent MASP-2 from binding to MBL and consequently the C4 cleavageactivity of the MBL-MASP complex is reduced. The regulatory mechanism ofsMAP in the lectin pathway remains to be investigated. It is stillunknown whether sMAP plays its regulatory role before or aftercomplement activation. sMAP may prevent inadvertent activation of theMBL-MASP complex before microbial infection or suppress overactivationof the lectin pathway once activated. There is another potentialregulator in the lectin pathway. MASP-3 is also a competitor of MASP-2in binding to MBL and down-regulates the C4 and C2 cleavage activity ofMASP-2 (Dahl et al, Immunity 15:127-135 (2001)). Although theinteraction between sMAP and MASP-3 has not been investigated, it ispossible that they are able to down-regulate activation of the lectinpathway cooperatively.

In this report we have demonstrated that sMAP and MASP-2 compete to bindMBL and sMAP has the ability to down-regulate the lectin pathway, whichis activated by the MBL-MASP complex. It is reasonable that sMAP alsoregulates another route of the lectin pathway activated by theficolin-MASP complex. MASP-2 and sMAP are also compete to bind mouseficolin A and down-regulate the C4 cleavage activity of the ficolinA-MASP complex (Y Endo et al, in preparation). A study of MBL null micewas recently reported (Shi et al, J Exp Med 199: 1379-1390 (2004). MBLnull mice have no C4 cleavage activity in the MBL lectin pathway and aresusceptible to Staphylococcus aureus infections. In the present study,sMAP−/− mice, which are also deficient in MASP-2, showed reductions inC3 cleavage activity besides C4 cleavage activity in the lectin pathway.Because of their impaired opsonizing activity, the sMAP-deficient micemay be susceptible to bacterial infections. Further investigation of thesMAP-deficient mice will clarify the function of the lectin pathway inprotection against infectious diseases.

Another important finding is that the addition of rsMAP to normal serumresults in a reduction in the activation of C4 (FIG. 26B). The lectinpathway has been also demonstrated to regulate inflammation and tissuedamage in several organs (de Vries et al, Am J Pathol 165:1677-1688(2004); Fiane et al, Circulation 108:849-856 (2003); Jordan et al,Circulation 104:1413-1418 (2001); Walsh et al, J Immunol 175:541-546(2005)). In MBL-deficient patients undergoing treatment for a thoracicabdominal aortic aneurysm, complement was not activated and levels ofproinflammatory markers were reduced following surgery (Fiane et al,Circulation 108:849-856 (2003)). Accumulated evidences have demonstratedthe potential pathophysiologic role of MBL during conditions of ischemiaand reperfusion in a variety of vascular beds. Therefore, the specificblockade of MBL or inhibition of the lectin complement pathway mayrepresent a therapeutically relevant strategy for the prevention ofischemia/perfusion-associated damage. Thus, it is possible that sMAP isone of the candidates for such an inhibitor, since it acts as anattenuator of the lectin pathway's activation.

Example 31

This Example demonstrates that MASP-2 is responsible for the C4 bypassactivation of C3.

Background/Rationale: Most recently, it has been shown that inhibitingthe alternate pathway protects the kidney from ischemic acute failure(Thurman et al., J. Immunol 170:1517-1523 (2003)). The data describedherein imply that the lectin pathway instructs alternatepathway-activation, which in turn amplifies complement activationsynergistically. We hypothesise that transient inhibition of the lectinpathway may also affect alternate pathway-activation and thus improvethe long-term outcome in organ transplantation as limitingcomplement-mediated graft damage and inflammation, and may moderate theunwanted induction of an adaptive immune response against the graft andreduce the risk of secondary graft rejection through the adaptive immunesystem. This is supported by recent clinical data showing that apartially impaired lectin pathway, resulting from inherited MBLdeficiencies (present in about 30% of the human population), isassociated with increased renal allograft survival in humans (Berger, AmJ Transplant 5:1361-1366 (2005)).

The involvement of complement components C3 and C4 inischemia-reperfusion (FR) injury was well established in models oftransient intestinal and muscular ischemia using gene targeted mousestrains (Weiser et al., J Exp Med 183:2342-2348 (1996); Williams et al.J Appl Physiol 86:938-42, (1999)). It is well established that C3 has aprominent role in renal FR injury and secondary graft rejection (Zhou etal., J Clin Invest 105:1363-1371 (2000); Pratt et al., Nat Med 8:582-587 (2002); Farrar, et al., Am J. Pathol 164:133-141 (2004)). It wastherefore surprising that a phenotype for C4 deficiency was not observedin the published models of mouse kidney allograft rejection (Lin, 2005In Press). A subsequent analysis of sera and plasma of these C4deficient mice, however, indicated that these mice retain a residualfunctional activity showing LP-dependent cleavage of C3 and furtherdownstream activation of complement (see FIG. 27C).

The existence of a functional C4-bypass (and C2-bypass) is a phenomenonpreviously described (but not fully characterised) by severalinvestigators (Miller et al., Proc Natl Acad Sci 72:418-22 (1975);Knutzen Steuer et al., J Immunol 143(7):2256-61 (1989); Wagner et al., JImmunol 163:3549-3558 (1999) and relates to the alternativepathway-independent C3-turnover in C4 (and C2) deficient sera.

Methods: Effects of the lectin pathway and the classical pathway on C3deposition. Mouse plasma (with EGTA/ Mg²⁺ as anticoagulant) was dilutedand re-calcified in 4.0 mM barbital, 145 mM NaCl, 2.0 mM CaCl₂, 1.0 mMMgCl₂, pH 7.4, then added to microtitre plates coated with mannan (asshown in FIG. 27A and 27C) or zymosan (as shown in FIG. 27B), andincubated for 90 min at 37° C. The plates were washed 3 times with 10 mMTris-Cl, 140 mM NaCl, 5.0 mM CaCl₂, 0.05% Tween 20, pH 7.4 then C3bdeposition was measured using an anti-mouse C3c antibody.

Results: The results shown in FIG. 27A-C are representative of 3independent experiments. When using the same sera in wells coated withimmunoglobulin complexes instead of mannan or zymosan, C3b depositionand Factor B cleavage are seen in WT (+/+) mouse sera and pooledMASP-2(−/−) sera, but not in C1q depleted sera (data not shown). Thisindicates that alternative pathway activation can be restored inMASP-2−/− sera when the initial C3b is provided via CP activity. FIG.27C depicts the surprising finding that C3 can efficiently be activatedin a lectin pathway-dependant fashion in C4 (−/−) deficient plasma. This“C4 bypass” is abolished by the inhibition of lectin pathway-activationthrough preincubation of plasma with soluble mannan or mannose.

It can be seen that C3b deposition on mannan and zymosan is severelycompromised in MASP-2 (−/−) deficient mice, even under experimentalconditions that according to many previously published papers onalterative pathway activation should be permissive for all threepathways. As shown in FIG. 27A-C, MASP-2 (−/−) deficient mouse plasmadoes not activate C4 via the lectin pathway and does not cleave C3,neither via the lectin pathway nor the alternative pathway. We thereforehypothesise that MASP-2 is required in this C4-bypass. Further progressin the identification of components likely to be involved in the lectinpathway-dependent C4-bypass was most recently reported by Prof. TeizoFujita. Plasma of C4 deficient mice crossed with Fujita's MASP-1/3deficient mouse strain loses the residual capacity of C4 deficientplasma to cleave C3 via the lectin pathway. This was restored by addingrecombinant MASP-1 to the combined C4 and MASP-1/3 deficient plasma(Takahashi, Mol Immunol 43: 153 (2006), suggesting that MASP-1 isinvolved in the formation of lectin pathway-derived complexes thatcleave C3 in absence of C4 (recombinant MASP-1 does not cleave C3, butit cleaves C2; Rossi et al., J Biol Chem 276: 40880-7 (2001); Chen etal., J Biol Chem 279:26058-65 (2004). We observed that MASP-2 isrequired for this bypass to be formed.

Although more functional and quantitative parameters and histology arerequired to consolidate this pilot study, its preliminary results lendstrong support to the hypothesis that complement activation via thelectin pathway contributes significantly to the pathophysiology of renalFR injury, as MASP-2−/− mice show a much quicker recovery of renalfunctions.

Example 32

This Example demonstrates that thrombin activation can occur followinglectin pathway activation under physiological conditions, anddemonstrates the extent of MASP-2 involvement. In normal rat serum,activation of the lectin pathway leads to thrombin activation (assessedas thrombin deposition) concurrent with complement activation (assessedas C4 deposition). As can be seen in FIGS. 28A and 28B, thrombinactivation in this system is inhibited by a MASP-2 blocking antibody(Fab2 format), exhibiting an inhibition concentration-response curve(FIG. 28B) that parallels that for complement activation (FIG. 28A).These data suggest that activation of the lectin pathway as it occurs intrauma will lead to activation of both complement and coagulationsystems in a process that is entirely dependent on MASP-2. By inference,MASP2 blocking antibodies may prove efficacious in mitigating cases ofexcessive systemic coagulation, e.g., disseminated intravascularcoagulation, which is one of the hallmarks leading to mortality in majortrauma cases.

Example 33

This Example provides results generated using a localized Schwartzmanreaction model of disseminated intravascular coagulation (“DIC”) inMASP-2−/− deficient and MASP-2+/+ sufficient mice to evaluate the roleof lectin pathway in DIC.

Background/Rationale:

As described supra, blockade of MASP-2 inhibits lectin pathwayactivation and reduces the generation of both anaphylatoxins C3a andC5a. C3a anaphylatoxins can be shown to be potent platelet aggregatorsin vitro, but their involvement in vivo is less well defined and therelease of platelet substances and plasmin in wound repair may onlysecondarily involve complement C3. In this Example, the role of thelectin pathway was analyzed in MASP-2 (−/−) and WT (+/+) mice in orderto address whether prolonged elevation of C3 activation is necessary togenerate disseminated intravascular coagulation.

Methods:

The MASP-2 (−/−) mice used in this study were generated as described in

Example 27. The localized Schwartzman reaction model was used in thisexperiment. The localized Schwartzman reaction (LSR) is alipopolysaccharide (LPS) -induced response with well-characterizedcontributions from cellular and humoral elements of the innate immunesystem. Dependent of the LSR on complement is well established (Polak,L., et al., Nature 223:738-739 (1969); Fong J. S. et al., J Exp Med134:642-655 (1971)). In the LSR model, the mice were primed for 4 hourswith TNF alpha (500 ng, intrascrotal), then the mice were anaesthetizedand prepared for intravital microscopy of the cremaster muscle. Networksof post-capillary venules (15-60 μm diameter) with good blood flow (1-4mm/s) were selected for observation. Animals were treated withfluorescent antibodies to selectively label neutrophils, or platelets.The network of vessels was sequentially scanned and images of allvessels were digitally recorded of later analysis. After recording thebasal state of the microcirculation, mice received a single intravenousinjection of LPS (100 μg), either alone or with the agents listed below.The same network of vessels was then scanned every 10 minutes for 1hour. Specific accumulation of fluorophores was identified bysubtraction of background fluorescence and enhanced by thresholding theimage. The magnitude of reactions was measured from recorded images. Theprimary measure of Schwartzman reactions was aggregate data.

The studies compared the MASP-2+/+ sufficient, or wild type, miceexposed to either a known complement pathway depletory agent, cobravenom factor (CVF), or a terminal pathway inhibitor (C5aR antagonist).The results (FIG. 29A) demonstrate that CVF as well as a C5aR antagonistboth prevented the appearance of aggregates in the vasculature. Inaddition, the MASP-2 −/− deficient mice (FIG. 29B) also demonstratedcomplete inhibition of the localized Schwartzman reaction, supportinglectin pathway involvement. These results clearly demonstrate the roleof MASP-2 in DIC generation and support the use of MASP-2 inhibitors forthe treatment and prevention of DIC.

Example 34

This Example describes the analysis of MASP-2 (−/−) mice in a MurineMyocardial Ischemia/Reperfusion Model.

Background/Rationale:

To assess the contribution of MASP-2 to inflammatory reperfusion damagefollowing an ischemic insult to the coronary artery, MASP-2 (−/−) andMASP-2 (+/+) mice were compared in the murine ischemia/reperfusion(MIRP) model as described by Marber et al., J. Clin Invest. 95:1446-1456(1995), and in a Langendorff isolated perfused mouse heart model.

Methods:

The MASP-2 (−/−) mice used in this study were generated as described inExample 27. The ischemic insult to the left ventricle was carried out ineight WT (MASP-2 (+/+) and eleven MASP-2 (−/−) mice using the methodsdescribed in Example 27. Infarct size (INF) and area at risk (AAR) weredetermined by planometry as described in Example 27.

Langendorff isolated-perfused mouse heart model: The method of preparinghearts from mice for the Langendorff isolated-perfused mouse heart modelwas carried out as described in F.J. Sutherland et al., Pharmacol Res41: 613 (2000). See also, A. M. Kabir et al,. Am J Physiol Heart CircPhysiol 291: H1893 (2006); Y. Nishino et al., Circ Res 103:307 (2008)and I. G. Webb et al., Cardiovasc Res (2010)).

Briefly described, six male WT (+/+) and nine male MASP-2 (−/−) micewere anesthetized with pentobarbital (300 mg/kg) and heparin (150 units)intra-peritoneally. Hearts were rapidly isolated and placed in ice coldmodified Krebs-Henselit buffer (KH, 118.5 mmol/l NaCl, 25.0 mmol/lNaHCO₃, 4.75 mmol KCl, KH₂PO₄ 1.18, MgSO₄ 1.19, D-glucose 11.0, andCaCl₂ 1.41. The excised heart was mounted onto a Langendorff apparatuswith a water jacket and retrogradely perfused at a constant pressure of80 mm Hg with KH buffer equilibrated with 95% O₂ and 5% CO₂. Thetemperature of the perfusate was maintained at 37° C. A fluid-filledballoon inserted into the left ventricle monitored contractile function.The balloon was gradually inflated until the end-diastolic pressure wasbetween 1 and 7 mm Hg. Atrial pacing was performed at 580 bpm with a0.075-mm silver wire (Advent). Coronary flow was measured by timedcollection of perfusate.

Infarction Assessment in Vitro

After retrograde perfusion commenced, the hearts were stabilized for 30min. For inclusion, all hearts had to fulfill the following criteria:coronary flow between 1.5 and 4.5 mL/min, heart rate >300 bpm (unpaced),left ventricular developed pressure >55 mm Hg, time from thoracotomy toaortic cannulation <3 min, and no persistent dysrhythmia duringstabilization. Global ischemia and reperfusion was then conducted in theabsence of serum. All hearts then underwent 30 mins of global ischemiaby clamping the aortic inflow tubing, followed by 2 h of reperfusion.

Electrical pacing was stopped when contraction ceased during ischemiaand restarted 30 min into reperfusion. After 2 h of reperfusion. Heartswere perfused for 1 min with 5 ml of 1% triphenyl tetrazolium chloride(TTC) in KH and then placed in an identical solution at 37° C. for 10min. The atria were then removed, and the hearts were blotted dry,weighed, and stored at −20° C. for up to 1 week.

Hearts were then thawed, placed in 2.5% glutaraldehyde for 1 minute, andset in 5% agarose. The agarose heart blocks were then sectioned fromapex to base in 0.7mm slices using a vibratome (Agar Scientific). Aftersectioning, slices were placed overnight in 10% formaldehyde at roomtemperature before transferring into PBS for an additional day at 4° C.Sections were then compressed between Perspex plates (0.57 mm apart) andimaged using a scanner (Epson model G850A). After magnification,planimetry was carried out using image analysis software (SigmaScan Pro5.0, SPSS) and surface area of the whole, and TTC-negative, leftventricular myocardium was transformed to volume by multiplication withtissue thickness. Within each heart, after summation of individualslices, TTC-negative infarction volume was expressed as a percentage of,or plotted against, left ventricular volume.

Results:

The size of infarcted area (pale), left ventricle (LV) area at risk(red) and normally perfused LV zone (blue) were outlined in each sectionby identification of their color appearance and color borders. Areaswere quantified on both sides of each slice and averaged by aninvestigator. Infarct volume was calculated as a % of risk zone (% RZ)for each animal.

FIG. 31A shows the evaluation of eight WT (+/+) mice and eleven MASP-2(−/−) mice for the determination of their infarct size after undergoingthe coronary artery occlusion and reperfusion technique described above.FIG. 31A graphically illustrates the mean area-at-risk (AAR, a measureof the area affected by ischemia) and infarct volumes (INF, a measure ofdamage to the myocardium) as a percentage of total myocardial volume. Asshown in FIG. 31A, while there is no difference in the AAR between thetwo groups, the INF volumes are significantly reduced in MASP-2 (−/−)mice as compared with their WT littermates, thus indicating a protectiveeffect from myocardial damage in the absence of MASP-2 in this model ofMIRP.

FIG. 31B graphically illustrates the relationship between INF plottedagainst the AAR as a % of left ventricle (LV) myocardial volume. Asshown in FIG. 31B, for any given AAR, MASP-2 (−/−) animals showed ahighly significant reduction in the size of their infarction incomparison with their WT littermates.

FIGS. 31C and 31D show the results of myocardial infarction in thebuffer-perfused hearts of WT (+/+) and MASP-2 (−/−) mice prepared inaccordance with the Langendorff isolated-perfused mouse heart model, inwhich global ischemia and reperfusion was carried out in the absence ofserum. As shown in FIGS. 31C and 31D, there was no difference observedin the resultant infarct volume (INF) between the hearts of the MASP-2(−/−) and WT (+/+) mice, suggesting that the difference in infarct sizesshown in FIGS. 31A and 31B are caused by plasma factors, and not by alower susceptibility of the myocardial tissue of MASP-2 (−/−) mice toischemic damage.

Taken together, these results demonstrate that MASP-2 deficiencysignificantly reduces myocardial damage upon reperfusion of an ischemicheart in the Murine Myocardial Ischemia/Reperfusion Model, and supportthe use of MASP-2 inhibitors to treat and prevent ischemia/reperfusioninjury.

Example 35

This Example describes the analysis of MASP-2 (−/−) mice in a MurineRenal Transplantation Model.

Background/Rationale:

The role of MASP-2 in the functional outcome of kidney transplantationwas assessed using a mouse model.

Methods:

The functional outcome of kidney transplantation was assessed using asingle kidney isograft into uninephrecomized recipient mice, with six WT(+/+) transplant recipients (B6), and six MASP-2 (−/−) transplantrecipients. To assess the function of the transplanted kidney, theremaining native kidney was removed from the recipient 5 days aftertransplantation, and renal function was assessed 24 hours later bymeasurement of blood urea nitrogen (BUN) levels.

Results:

FIG. 32 graphically illustrates the blood urea nitrogen (BUN) levels ofthe kidney at 6 days post kidney transplant in the WT (+/+) recipientsand the MASP-2 (−/−) recipients. As shown in FIG. 32, strongly elevatedBUN levels were observed in the WT (+/+) (B6) transplant recipients(normal BUN levels in mice are <5 mM), indicating renal failure. Incontrast, MASP-2 (−/−) isograft recipient mice showed substantiallylower BUN levels, suggesting improved renal function. It is noted thatthese results were obtained using grafts from WT (+/+) kidney donors,suggesting that the absence of a functional lectin pathway in thetransplant recipient alone is sufficient to achieve a therapeuticbenefit.

Taken together, these results indicate that transient inhibition of thelectin pathway via MASP-2 inhibition provides a method of reducingmorbidity and delayed graft function in renal transplantation, and thatthis approach is likely to be useful in other transplant settings.

Example 36

This Example demonstrates that MASP-2 (−/−) mice are resistant to septicshock in a Murine Polymicrobial Septic Peritonitis Model.

Background/Rationale:

To evaluate the potential effects of MASP-2 (−/−) in infection, thececal ligation and puncture (CLP) model, a model of polymicrobial septicperitonitis was evaluated. This model is thought to most accuratelymimic the course of human septic peritonitis. The cecal ligation andpuncture (CLP) model is a model in which the cecum is ligated andpunctured by a needle, leading to continuous leakage of the bacteriainto the abdominal cavity which reach the blood through the lymphdrainage and are then distributed into all the abdominal organs, leadingto multi-organ failure and septic shock (Eskandari et al., J Immunol148(9):2724-2730 (1992)). The CLP model mimics the course of sepsisobserved in patients and induces an early hyper-inflammatory responsefollowed by a pronounced hypo-inflammatory phase. During this phase, theanimals are highly sensitive to bacterial challenges (Wichterman et al.,J. Surg. Res. 29(2):189-201 (1980)).

Methods:

The mortality of polymicrobial infection using the cecal ligation andpuncture (CLP) model was measured in WT (+/+) (n=18) and MASP-2 (−/−)(n=16) mice as described in Example 23. Briefly described, MASP-2deficient mice and their wild-type littermates were anaesthetized andthe cecum was exteriorized and ligated 30% above the distal end. Afterthat, the cecum was punctured once with a needle of 0.4 mm diameter. Thececum was then replaced into the abdominal cavity and the skin wasclosed with clamps. The survival of the mice subjected to CLP wasmonitored over a period of 14 days after CLP. A peritoneal lavage wascollected in mice 16 hours post CLP to measure bacterial load. Serialdilutions of the peritoneal lavage were prepared in PBS and inoculatedin Mueller Hinton plates with subsequent incubation at 37° C. underanaerobic conditions for 24 hours after which bacterial load wasdetermined.

The TNF-alpha cytokine response to the bacterial infection was alsomeasured in the

WT (+/+) and MASP-2 (−/−) mice 16 hours after CLP in lungs and spleensvia quantitative real time polymerase chain reaction (qRT-PCR). Theserum level of TNF-alpha 16 hours after CLP in the WT (+/+) and MASP-2(−/−) mice was also quantified by sandwich ELISA.

Results:

FIG. 33 graphically illustrates the percentage survival of the CLPtreated animals as a function of the days after the CLP procedure. Asshown in FIG. 33, the lectin pathway deficiency in the MASP-2 (−/−) micedoes not increase the mortality of mice after polymicrobial infectionusing the cecal ligation and puncture model as compared to WT (+/+)mice. However, as shown in FIG. 34, MASP-2 (−/−) mice showed asignificantly higher bacterial load (approximately a 1000-fold increasein bacterial numbers) in peritoneal lavage after CLP when compared totheir WT (+/+) littermates. These results indicate that MASP-2 (−/−)deficient mice are resistant to septic shock. The reduced bacterialclearance in MASP-2 deficient mice in this model may be due to animpaired C3b mediated phagocytosis, as it was demonstrated that C3deposition is MASP-2 dependent.

It was determined that the TNF-alpha cytokine response to the bacterialinfection was not elevated in the MASP-2 (−/−) mice as compared to theWT (+/+) controls (data not shown). It was also determined that therewas a significantly higher serum concentration of TNF-alpha in WT (+/+)mice 16 hours after CLP in contrast to MASP-2 (−/−) mice, where theserum level of TNF-alpha remained nearly unaltered. These resultssuggest that the intense inflammatory response to the septic conditionwas tempered in MASP-2 (−/−) mice and allowed the animals to survive inthe presence of higher bacterial counts.

Taken together, these results demonstrate the potential deleteriouseffects of lectin pathway complement activation in the case ofsepticemia and the increased mortality in patients with overwhelmingsepsis. These results further demonstrate that MASP-2 deficiencymodulates the inflammatory immune response and reduces the expressionlevels of inflammatory mediators during sepsis. Therefore, it isbelieved that inhibition of MASP-2 (−/−) by administration of inhibitorymonoclonal antibodies against MASP-2 would be effective to reduce theinflammatory response in a subject suffering from septic shock.

Example 37

This Example describes analysis of MASP-2 (−/−) mice in a MurineIntranasal Infectivity Model.

Background/Rationale:

Pseudomonas aeruginosa is a Gram negative opportunistic human bacterialpathogen that causes a wide range of infections, particularly inimmune-compromised individuals. It is a major source of acquirednosocomial infections, in particular hospital-acquired pneumonia. It isalso responsible for significant morbidity and mortality in cysticfibrosis (CF) patients. P. aeruginosa pulmonary infection ischaracterized by strong neutrophil recruitment and significant lunginflammation resulting in extensive tissue damage (Palanki M. S. et al.,J. Med. Chem 51:1546-1559 (2008)).

In this Example, a study was undertaken to determine whether the removalof the lectin pathway in MASP-2 (−/−) mice increases the susceptibilityof the mice to bacterial infections.

Methods:

Twenty-two WT (+/+) mice, twenty-two MASP-2 (−/−) mice, and eleven C3(−/−) mice were challenged with intranasal administration of P.aeruginosa bacterial strain. The mice were monitored over the six dayspost-infection and Kaplan-Mayer plots were constructed showing percentsurvival.

Results:

FIG. 35 is a Kaplan-Mayer plot of the percent survival of WT (+/+),MASP-2 (−/−) or C3 (−/−) mice six days post-infection. As shown in FIG.35, no differences were observed in the MASP-2 (−/−) mice versus the WT(+/+) mice. However, removal of the classical (Clq) pathway in the C3(−/−) mice resulted in a severe susceptibility to bacterial infection.These results demonstrate that MASP-2 inhibition does not increasesusceptibility to bacterial infection, indicating that it is possible toreduce undesirable inflammatory complications in trauma patients byinhibiting MASP-2 without compromising the patient's ability to fightinfections using the classical complement pathway.

Example 38

This Example describes the pharmacodynamic analysis of representativehigh affinity anti-MASP-2 Fab2 antibodies that were identified asdescribed in Example 24.

Background/Rationale:

As described in Example 24, in order to identify high-affinityantibodies that block the rat lectin pathway, rat MASP-2 protein wasutilized to pan a phage display library. This library was designed toprovide for high immunological diversity and was constructed usingentirely human immunoglobin gene sequences. As shown in Example 24,approximately 250 individual phage clones were identified that boundwith high affinity to the rat MASP-2 protein by ELISA screening.Sequencing of these clones identified 50 unique MASP-2 antibody encodingphage. Fab2 protein was expressed from these clones, purified andanalyzed for MASP-2 binding affinity and lectin complement pathwayfunctional inhibition.

As shown in TABLE 6 of Example 24, 17 anti-MASP-2 Fab2s with functionalblocking activity were identified as a result of this analysis (a 34%hit rate for blocking antibodies). Functional inhibition of the lectincomplement pathway by Fab2s was apparent at the level of C4 deposition,which is a direct measure of C4 cleavage by MASP-2. Importantly,inhibition was equally evident when C3 convertase activity was assessed,demonstrating functional blockade of the lectin complement pathway. The17 MASP-2 blocking Fab2s identified as described in Example 24 potentlyinhibit C3 convertase formation with IC₅₀ values equal to or less than10 nM. Eight of the 17 Fab2s identified have IC₅₀ values in thesub-nanomolar range. Furthermore, all 17 of the MASP-2 blocking Fab2sgave essentially complete inhibition of the C3 convertase formation inthe lectin pathway C3 convertase assay, as shown in FIGS. 11A-C, andsummarized in TABLE 6 of Example 24. Moreover, each of the 17 blockinganti-MASP-2 Fab2s shown in TABLE 6 potently inhibit C3b generation(>95%), thus demonstrating the specificity of this assay for lectinpathway C3 convertase.

Rat IgG2c and mouse IgG2a full-length antibody isotype variants werederived from Fab2 #11. This Example describes the in vivocharacterization of these isotypes for pharmacodynamic parameters.

Methods:

As described in Example 24, rat MASP-2 protein was utilized to pan a Fabphage display library, from which Fab2#11 was identified. Rat IgG2c andmouse IgG2a full-length antibody isotype variants were derived from Fab2#11. Both rat IgG2c and mouse IgG2a full length antibody isotypes werecharacterized in vivo for pharmacodynamic parameters as follows.

In Vivo Study in Mice:

A pharmacodynamic study was carried out in mice to investigate theeffect of anti-MASP-2 antibody dosing on the plasma lectin pathwayactivity in vivo. In this study, C4 deposition was measured ex vivo in alectin pathway assay at various time points following subcutaneous (sc)and intraperitoneal (ip) administration of 0.3 mg/kg or 1.0 mg/kg of themouse anti-MASP-2 MoAb (mouse IgG2a full-length antibody isotype derivedfrom Fab2#11).

FIG. 36 graphically illustrates lectin pathway specific C4b deposition,measured ex vivo in undiluted serum samples taken from mice (n=3mice/group) at various time points after subcutaneous dosing of either0.3 mg/kg or 1.0 mg/kg of the mouse anti-MASP-2 MoAb. Serum samples frommice collected prior to antibody dosing served as negative controls(100% activity), while serum supplemented in vitro with 100 nM of thesame blocking anti-MASP-2 antibody was used as a positive control (0%activity).

The results shown in FIG. 36 demonstrate a rapid and complete inhibitionof C4b deposition following subcutaneous administration of 1.0 mg/kgdose of mouse anti-MASP-2 MoAb. A partial inhibition of C4b depositionwas seen following subcutaneous administration of 0.3 mg/kg dose ofmouse anti-MASP-2 MoAb.

The time course of lectin pathway recovery was followed for three weeksfollowing a single ip administration of mouse anti-MASP-2 MoAb at 0.6mg/kg in mice. As shown in FIG. 37, a precipitous drop in lectin pathwayactivity occurred post antibody dosing followed by complete lectinpathway inhibition that lasted for about 7 days after ip administration.Slow restoration of lectin pathway activity was observed over the secondand third weeks, with complete lectin pathway restoration in the mice by17 days post anti-MASP-2 MoAb administration.

These results demonstrate that the mouse anti-MASP-2 Moab derived fromFab2 #11 inhibits the lectin pathway of mice in a dose-responsive mannerwhen delivered systemically.

Example 39

This Example describes analysis of the mouse anti-MASP-2 Moab derivedfrom Fab2 #11 for efficacy in a mouse model for age-related maculardegeneration.

Background/Rationale:

As described in Example 24, rat MASP-2 protein was utilized to pan a Fabphage display library, from which Fab2#11 was identified as afunctionally active antibody. Full length antibodies of the rat IgG2cand mouse IgG2a isotypes were generated from Fab2 #11. The full lengthanti-MASP-2 antibody of the mouse IgG2a isotype was characterized forpharmacodynamic parameters as described in Example 38. In this Example,the mouse anti-MASP-2 full-length antibody derived from Fab2 #11 wasanalyzed in the mouse model of age-related macular degeneration (AMD),described by Bora P. S. et al, J Immunol 174:491-497 (2005).

Methods:

The mouse IgG2a full-length anti-MASP-2 antibody isotype derived fromFab2 #11 as described in Example 38, was tested in the mouse model ofage-related macular degeneration (AMD) as described in Example 28 withthe following modifications.

Administration of Mouse-Anti-MASP-2 MoAbs

Two different doses (0.3 mg/kg and 1.0 mg/kg) of mouse anti-MASP-2 MoAbalong with an isotype control MoAb treatment were injected ip into WT(+/+) mice (n=8 mice per group) 16 hours prior to CNV induction

Induction of Choroidal Neovascularization (CNV)

The induction of choroidal neovascularization (CNV) and measurement ofthe volume of CNV was carried out using laser photocoagulation asdescribed in Example 28.

Results:

FIG. 38 graphically illustrates the CNV area measured at 7 days postlaser injury in mice treated with either isotype control MoAb, or mouseanti-MASP-2 MoAb (0.3 mg/kg and 1.0 mg/kg). As shown in FIG. 38, in themice pre-treated with 1.0 mg/kg anti-MASP-2 MoAb, a statisticallysignificant (p <0.01) approximately 50% reduction in CNV was observedseven days post-laser treatment. As further shown in FIG. 38, it wasobserved that a 0.3 mg/kg dose of anti-MASP-2 MoAb was not efficaciousin reducing CNV. It is noted that the 0.3 mg/kg dose of anti-MASP-2 MoAbwas shown to have a partial and transient inhibition of C4b depositionfollowing subcutaneous administration, as described in Example 38 andshown in FIG. 36.

The results described in this Example demonstrate that blockade ofMASP-2 with an inhibitor, such as anti-MASP-2 MoAb, has a preventativeand/or therapeutic effect in the treatment of macular degeneration. Itis noted that these results are consistent with the results observed inthe study carried out in the MASP-2 (−/−) mice, described in Example 28,in which a 30% reduction in the CNV 7 days post-laser treatment wasobserved in MASP-2 (−/−) mice in comparison to the wild-type controlmice. Moreover, the results in this Example further demonstrate thatsystemically delivered anti-MASP-2 antibody provides local therapeuticbenefit in the eye, thereby highlighting the potential for a systemicroute of administration to treat AMD patients. In summary, these resultsprovide evidence supporting the use of MASP-2 MoAb in the treatment ofAMD.

Example 40

This Example demonstrates that MASP-2 deficient mice are protected fromNeisseria meningitidis induced mortality after infection with N.meningitidis and have enhanced clearance of bacteraemia as compared towild type control mice.

Rationale: Neisseria meningitidis is a heterotrophic gram-negativediplococcal bacterium known for its role in meningitis and other formsof meningococcal disease such as meningococcemia. N. meningitidis is amajor cause of morbidity and mortality during childhood. Severecomplications include septicaemia, Waterhouse-Friderichsen syndrome,adrenal insufficiency and disseminated intravascular coagulation (DIC).See e.g., Rintala E. et al., Critical Care Medicine 28(7):2373-2378(2000). In this Example, the role of the lectin pathway was analyzed inMASP-2 (−/−) and WT (+/+) mice in order to address whether MASP-2deficient mice would be susceptible to N. meningitidis inducedmortality.

Methods:

MASP-2 knockout mice were generated as described in Example 27. 10 weekold MASP-2 KO mice (n=10) and wild type C57/B6 mice (n=10) wereinnoculated by intravenous injection with either a dosage of 5×10⁸cfu/100 μl 2×10⁸ cfu/100 μl or 3×10⁷ cfu/100 μl of Neisseriameningitidis Serogroup A Z2491 in 400 mg/kg iron dextran.

Survival of the mice after infection was monitored over a 72 hour timeperiod. Blood samples were taken from the mice at hourly intervals afterinfection and analyzed to determine the serum level (log cfu/ml) of N.meningitidis in order to verify infection and determine the rate ofclearance of the bacteria from the serum.

Results:

FIG. 39A graphically illustrates the percent survival of MASP-2 KO andWT mice after administration of an infective dose of 5×10⁸/100 μl cfu N.meningitidis. As shown in FIG. 39A, after infection with the highestdose of 5×10⁸/100 μl cfu N. meningitidis, 100% of the MASP-2 KO micesurvived throughout the 72 hour period after infection. In contrast,only 20% of the WT mice were still alive 24 hours after infection. Theseresults demonstrate that MASP-2 deficient mice are protected from N.meningitidis induced mortality.

FIG. 39B graphically illustrates the log cfu/ml of N. meningitidisrecovered at different time points in blood samples taken from theMASP-2 KO and WT mice infected with 5×10⁸ cfu/100 μl N. meningitidis. Asshown in FIG. 39B, in WT mice the level of N. meningitidis in the bloodreached a peak of about 6.5 log cfu/ml at 24 hours after infection anddropped to zero by 48 hours after infection. In contrast, in the MASP-2KO mice, the level of N. meningitidis reached a peak of about 3.5 logcfu/ml at 6 hours after infection and dropped to zero by 36 hours afterinfection. FIG. 40A graphically illustrates the percent survival ofMASP-2 KO and WT mice after infection with 2×10⁸ cfu/100 μl N.meningitidis. As shown in FIG. 40A, after infection with the dose of2×10⁸ cfu/100 μl N. meningitidis, 100% of the MASP-2 KO mice survivedthroughout the 72 hour period after infection. In contrast, only 80% ofthe WT mice were still alive 24 hours after infection. Consistent withthe results shown in FIG. 39A, these results further demonstrate thatMASP-2 deficient mice are protected from N. meningitidis inducedmortality.

FIG. 40B graphically illustrates the log cfu/ml of N. meningitidisrecovered at different time points in blood samples taken from the WTmice infected with 2×10⁸ cfu/100 μl N. meningitidis. As shown in FIG.40B, the level of N. meningitidis in the blood of WT mice infected with2×10⁸ cfu reached a peak of about 4 log cfu/ml at 12 hours afterinfection and dropped to zero by 24 hours after infection. FIG. 40Cgraphically illustrates the log cfu/ml of N. meningitidis recovered atdifferent time points in blood samples taken from the MASP-2 KO miceinfected with 2×10⁸ cfu/100 μl N. meningitidis. As shown in FIG. 40C,the level of N. meningitidis in the blood of MASP-2 KO mice infectedwith 2×10⁸ cfu reached a peak level of about 3.5 log cfu/ml at 2 hoursafter infection and dropped to zero at 3 hours after infection.Consistent with the results shown in FIG. 39B, these results demonstratethat although the MASP-2 KO mice were infected with the same dose of N.meningitidis as the WT mice, the MASP-2 KO mice have enhanced clearanceof bacteraemia as compared to WT.

The percent survival of MASP-2 KO and WT mice after infection with thelowest dose of 3×10⁷ cfu/100 μl N. meningitidis was 100% at the 72 hourtime period (data not shown).

Discussion

These results show that MASP-2 deficient mice are protected from N.meningitidis induced mortality and have enhanced clearance ofbacteraemia as compared to the WT mice. Therefore, in view of theseresults, it is expected that therapeutic application of MASP-2inhibitors, such as MASP-2 MoAb, would be expected to be efficacious totreat, prevent or mitigate the effects of infection with N. meningitidisbacteria (i.e., sepsis and DIC). Further, these results indicate thattherapeutic application of MASP-2 inhibitors, such as MASP-2 MoAb wouldnot predispose a subject to an increased risk to contract N.meningitidis infections.

While illustrative embodiments have been illustrated and described, itwill be appreciated that various changes can be made therein withoutdeparting from the spirit and scope of the invention.

The embodiments of the invention in which an exclusive property orprivilege is claimed are defined as follows:
 1. A method of inhibitingsystemic coagulation in a subject suffering from a complement-mediatedcoagulation disorder, comprising administering to the subject an amountof a MASP 2 inhibitory agent effective to selectively inhibit MASP 2dependent complement activation.
 2. The method of claim 1, wherein theMASP-2 inhibitory agent is a MASP-2 antibody or fragment thereof.
 3. Themethod of claim 2, wherein the MASP-2 antibody or fragment thereofspecifically binds to a portion of SEQ ID NO:6.
 4. The method of claim2, wherein the MASP-2 antibody or fragment thereof is monoclonal.
 5. Themethod of claim 2, wherein the MASP-2 antibody or fragment thereof is arecombinant antibody.
 6. The method of claim 2, wherein the antibody isa chimeric, humanized or human antibody.
 7. The method of claim 2,wherein the antibody has reduced effector function.
 8. The method ofclaim 1, wherein the MASP-2 inhibitory agent selectively inhibitsMASP-2-dependent complement activation without substantially inhibitingC1q-dependent complement activation.
 9. The method of claim 1, whereinthe MASP 2 inhibitory agent specifically binds to a polypeptidecomprising SEQ ID NO: 6 with an affinity of at least 10 times greaterthan it binds to a different antigen in the complement system.
 10. Themethod of claim 1, wherein the MASP-2 inhibitory agent is administeredsystemically to the subject.
 11. The method of claim 1, wherein thecomplement-mediated coagulation disorder is secondary to a malignancy.12. The method of claim 1, wherein the complement-mediated coagulationdisorder is secondary to a transplant rejection.
 13. The method of claim1, wherein the complement-mediated coagulation disorder is secondary toa transfusion reaction,.
 14. The method of claim 1, wherein thecomplement-mediated coagulation disorder is secondary to an obstetriccomplication.
 15. The method of claim 1, wherein the complement-mediatedcoagulation disorder is secondary to a vascular aneurysm.
 16. The methodof claim 1, wherein the complement-mediated coagulation disorder issecondary to hepatic failure.
 17. The method of claim 1, wherein thecomplement-mediated coagulation disorder is secondary to heat stroke.18. The method of claim 1, wherein the complement-mediated coagulationdisorder is secondary to a burn.
 19. The method of claim 1, wherein thecomplement-mediated coagulation disorder is secondary to radiationexposure.
 20. The method of claim 1, wherein the complement-mediatedcoagulation disorder is secondary to a severe toxic reaction.
 21. Themethod of claim 1, wherein the complement-mediated coagulation disorderis secondary to sepsis.
 22. The method of claim 1, wherein thecomplement-mediated coagulation disorder is secondary to an infection.23. The method of claim 1, wherein the complement-mediated coagulationdisorder is secondary to trauma.
 24. The method of claim 1, wherein thecomplement-mediated coagulation disorder is secondary to surgery.